COST-UTILITY ANALYSIS FROM VARYING RATES OF SCREENING AND FOLLOW-UP COLONOSCOPY: REAL-WORLD ANALYSIS OF TAIWAN COLORECTAL CANCER SCREENING PROGRAM
Author(s)
Wei-Ying Chen, MD1, Hsiu-Chi Cheng, PhD2, Fuhmei Wang, PhD3, Yu-Wen Chien, PhD2, Jung-Der Wang, ScD, MD2.
1student, National Cheng Kung University, Tainan, Taiwan, 2National Cheng Kung University College of Medicine, Tainan, Taiwan, 3National Cheng Kung University, Tainan, Taiwan.
1student, National Cheng Kung University, Tainan, Taiwan, 2National Cheng Kung University College of Medicine, Tainan, Taiwan, 3National Cheng Kung University, Tainan, Taiwan.
OBJECTIVES: To evaluate the cost-utility of different screening rates and follow-up colonoscopy (FU-CY) adherence rates for a fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening program in Taiwan.
METHODS: Costs and clinical benefits were derived from a real-world CRC screening database (2010-2017) based on screening-induced stage-shift to conduct a 2018-centered cost-utility analysis. Real-world 2018 parameters established baseline screening rates (20.9% women, 16.2% men) and FU-CY rates after a positive FIT (68.2% women, 67.6% men). We estimated cost per QALY gained for five screening rates (20%-100%) against five FU-CY rates (100% down to 20%, in 20% decrements) from healthcare system (direct costs) and societal (including lifetime productivity) perspectives.
RESULTS: In 2018, screen-detected CRC cases were 1,069 for women and 1,477 for men. Under a 20% screening rate, 100% FU-CY would save 6,743 QALYs for men and 3,899 QALYs for women. Direct-costs-only analysis showed that the program would be consistently dominant (cost-saving) for men across all FU-CY rates if the screening rate were above 20%. However, for women at a 20% screening rate, the program was not cost-saving under direct costs alone, ranging from $2000 USD (100% FU-CY) up to $3800 USD (20% FU-CY) per QALY gained. After accounting for the savings from lifetime productivity loss in women, however, the program would show a net-zero cost at 60% FU-CY ($0.0 USD/QALY) and achieve cost savings beyond that level: -$100 USD at 80% FU-CY; -$200 USD at 100% FU-CY.
CONCLUSIONS: While the Taiwan CRC screening program seemed robustly cost-saving for men, its economic viability for women appeared highly sensitive to gender-specific parameters. Although the program incurred net costs for women at a 20% screening rate, it would be cost-saving after accounting for lifetime productivity if the FU-CY rates were ≥ 80%.
METHODS: Costs and clinical benefits were derived from a real-world CRC screening database (2010-2017) based on screening-induced stage-shift to conduct a 2018-centered cost-utility analysis. Real-world 2018 parameters established baseline screening rates (20.9% women, 16.2% men) and FU-CY rates after a positive FIT (68.2% women, 67.6% men). We estimated cost per QALY gained for five screening rates (20%-100%) against five FU-CY rates (100% down to 20%, in 20% decrements) from healthcare system (direct costs) and societal (including lifetime productivity) perspectives.
RESULTS: In 2018, screen-detected CRC cases were 1,069 for women and 1,477 for men. Under a 20% screening rate, 100% FU-CY would save 6,743 QALYs for men and 3,899 QALYs for women. Direct-costs-only analysis showed that the program would be consistently dominant (cost-saving) for men across all FU-CY rates if the screening rate were above 20%. However, for women at a 20% screening rate, the program was not cost-saving under direct costs alone, ranging from $2000 USD (100% FU-CY) up to $3800 USD (20% FU-CY) per QALY gained. After accounting for the savings from lifetime productivity loss in women, however, the program would show a net-zero cost at 60% FU-CY ($0.0 USD/QALY) and achieve cost savings beyond that level: -$100 USD at 80% FU-CY; -$200 USD at 100% FU-CY.
CONCLUSIONS: While the Taiwan CRC screening program seemed robustly cost-saving for men, its economic viability for women appeared highly sensitive to gender-specific parameters. Although the program incurred net costs for women at a 20% screening rate, it would be cost-saving after accounting for lifetime productivity if the FU-CY rates were ≥ 80%.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA4
Topic
Economic Evaluation, Health Technology Assessment, Real World Data & Information Systems
Topic Subcategory
Systems & Structure
Disease
Gastrointestinal Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Oncology