Abstract for: Cost-effectiveness Analysis of Increasing Access to Colorectal Cancer Diagnostic Approaches: an Example from Thailand

Objectives: We aim to conduct an economic evaluation of increasing access to diagnostic approaches and colonoscopy capacity building in Thailand. Methods: We conducted a cost-effectiveness analysis using Colo-Sim, a system dynamics model of CRC care in Thailand. We analyzed improvement in access to the fecal immunochemical test (FIT) screening (strategy-I), symptom evaluation (strategy-II), and both (strategy-III). We analyzed these strategies in combination with the 8-point risk score (RS) and under current versus increasing colonoscopy capacity to a sufficient level (SC). We estimated the quality-adjusted life years (QALYs) gained and costs from each strategy over 25 years. Results: Under the current willingness-to-pay (WTP) in Thailand (160,000 THB), strategy-III+RS+SC results in the highest QALY gained (2.6M) and an additional cost of 158B THB with 95% chance of being cost-effective compared to the status quo. Each strategy combined with RS or SC results in a more cost-effective approach than strategies without RS or SC. Conclusions: A combination of strategies, including increasing access to FIT screening and symptom evaluation, using the 8-point risk score, and building more colonoscopy capacity, has the potential to be the most cost-effective strategy.