Introduction
A small-scale study modeled the cost-effectiveness of colorectal cancer (CRC) screening, incorporating productivity factors.
Aims & Methods
Using real-world data, this research aimed to evaluate the cost-utility of Taiwan's CRC screening program, factoring in potential lifetime productivity savings. After interlinkages among databases of the Taiwan Cancer Registry, National Mortality Registry, Taiwan CRC Screening Database, and National Health Insurance claim records, we estimated lifetime survival functions for stage-specific subcohorts using a rolling extrapolation algorithm after stratified by sex and age from 2004 to 2017. We multiplied the survival rates with average utility values of EQ-5D collected from CRC cases at National Cheng Kung University Hospital, to sum up quality-adjusted life expectancy (QALE). We multiplied monthly medical costs and insured salaries by survival probabilities. We summed them over a lifetime for both the index and age-, sex-, and calendar-year matched reference subcohorts for comparison. Lifetime productivity (LP) was assessed only up to age 65. After weighing different stage distributions, we calculated the differences in total QALE loss, lifetime medical expenditures (LME), and LP between screened versus non-screened groups. Finally, we estimated the costs associated with implementing fecal immunochemical testing (FIT) in Taiwan's CRC screening program. We applied a 3% annual discount and an exchange rate of 30.58 New Taiwan Dollars per U.S. Dollar (USD) at the end of 2018.
Results
We enrolled 77,169 CRC patients aged 50–74 in the study. After weighted by different stage distribution, a screen-detected CRC case would save 2.6 (95% CI, 2.3–2.9) and 2.5 (95% CI, 2.1–2.6) QALYs for women and men, respectively, accompanied by 7,000 USD (95% CI, 4,000–10,000) and 8,000 USD (95% CI, 6,000–10,000) in LME, and 17,000 USD (95% CI, 16,000–19,000) and 23,000 USD (95% CI, 22,000–25,000) in LP. For every 100,000 persons screened, the program spent 682,000 USD for FIT, 1,051,000 USD and 1,987,000 USD for men and women, respectively, for colonoscopy, 61,000 USD and 133,000 USD for surveillance colonoscopy and 9,000 USD and 15,000 USD for treating complications. The incremental cost-utility ratio (ICUR) of 6,650 and 6,230 USD per QALY for women and men, respectively, would become 120 and -2970 USD per QALY after accounting for lifetime productivity.
Conclusion
After considering lifetime productivity, Taiwan's CRC screening program would be close to being cost-saving. Future corroboration studies are warranted.