OBJECTIVES:

With the rise of colorectal cancer incidences, the Philippine Health Insurance Corporation, the nation's universal health coverage provider, is aiming for implementing colorectal cancer screening interventions. This study conducted a nationwide lifetime cost-utility analysis and budget impact analysis of multiple colorectal cancer screening strategies among the population aged 50 and above in the Philippines.

METHODS: An agent-based discrete event micro-simulation model following the payer's perspective was used to simulate four screening interventions. These four screening interventions are: Annual gFOBT or FIT confirmed by colonoscopy, Flexible Sigmoidoscopy every 5 years confirmed by colonoscopy, and colonoscopy screening every 10 years. Health and cost data gathered from national hospitals and secondary data derived from related studies have been used to populate the parameters of the model for simulation. Quality-adjusted life years (QALYs) gained, total costs, and Incremental Cost-effectiveness Ratios (ICERs) were calculated per screening intervention. The budget impact analysis was calculated from the results of the micro-simulation model.

RESULTS:

The screening interventions using gFOBT or FIT have been determined to be cost-saving, with a reduced cost of ₱1,700 - ₱2,300 per cohort, with an increase in QALYS by 1.23 - 1.38 per cohort. The other screening interventions were also cost-effective, considering the ICERs fall below the 1 GDP per capita threshold of the World Health Organization. One way sensitivity analysis was conducted for multiple parameters, such as cost, compliance, and accuracy of the screening tests. Results show that the ICERs of all the screening modalities evaluated remained below the 1 GDP per capita. For the budget impact analysis, the least cost strategies were the gFOBT and FIT interventions with an estimated ₱250M - ₱350M for a nationwide implementation.

CONCLUSIONS:

Screening strategies using gFOBT or FIT has been determined to be the most viable screening strategies for implementing a nationwide colorectal cancer screening program for the Philippines.