Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand

Abstract

Aims: Colorectal cancer(CRC) is one of the public health burdens that can be lowered by early detection. This study aims to examine the preferences and willingness-to-pay of a population at risk for CRC screening in Thailand. Understanding the preferences for these individuals at risk would help Thailand, as an example of LMICs, to design effective population-based CRC screening programs. Materials and Methods: A discrete choice experiment (DCE) was conducted among screening-naïve adults aged 50-75 years, who were at risk of CRC, in the outpatient department of a tertiary care hospital in Thailand. A DCE questionnaire was developed from six CRC screening attributes. Each questionnaire was composed of six choice sets and each contained two alternatives described by the different levels of attributes, and an opt-out alternative. Participants were asked to choose one alternative from each choice set. A multinomial logit model was developed to determine the relative preference of each attribute. The willingness-to-pays for all attributes and screening modalities and the estimated preferred choices of annual fecal immunochemical test (FIT), 10-yearly colonoscopy, 5yearly double-contrast barium enema (DCBE), 5-yearly computed tomographic colonography (CTC), 5-yearly flexible sigmoidoscopy (FS), and no screening were calculated and compared. Results: Four hundred participants were included. All attributes, except pain and less bowel preparation, were statistically associated with the participants' preference (p<0.05). They preferred screenings with high risk reduction of CRC-related mortality, no complication, 5year interval, and lower cost. The estimated preferred choices of FIT, colonoscopy, DCBE,

Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population?

“…There are two prominent trends in population preference for CRC screening tests reported in previous studies: people preferred either the most accurate test (visual or structural test: colonoscopy) [29,31,[41][42][43][44][45][46][47][48][49][50][51] or the least invasive one (stool-based test: fecal occult blood test (FOBT) or stool DNA (sDNA) test) [26,28,[52][53][54][55][56][57][58]. While both tests are highly recommended by international guidelines [5][6][7][8], with colonoscopy recommended as the gold standard test and stool-based test (iFOBT or gFOBT) as the standard firstline test for population-based CRC screening, population preference for colonoscopy and stool-based tests, as well as the other available screening techniques, has not been systematically reviewed.…”

“…Stool-based tests were the second most commonly stated as population's preferred tests for CRC screening, with FOBT more commonly reported (six studies, six countries (Isarael, Palestine, UK, USA, Australia, and Thailand)) [28,52,53,55,56,58] than sDNA (two studies, only in USA [54,57]). In these studies, FOBT was offered either with only colonoscopy [28,53,55,59] or with a group of the available tests including colonoscopy [52,56,58], sigmoidoscopy [52,56,58], and radiological tests [56] (barium enema [52,58] and/or CTC [58]). sDNA testing was compared with colonoscopy [54,57,61], FOBT [54,57,61], sigmoidoscopy [61], virtual colonoscopy [61] and barium enema [61].…”

“…sDNA testing was compared with colonoscopy [54,57,61], FOBT [54,57,61], sigmoidoscopy [61], virtual colonoscopy [61] and barium enema [61]. The percentages of individuals choosing stool-based test as their most favored screening test ranged from 38.2% to 84% [26,28,[52][53][54][55][56][57][58].…”

“…Feeling of "disgust" is also commonly reported [52,107]. Bowel preparation in particular, described as "horrible" from subjects interviewed by Dyer et al [107], represents a significant barrier to screening [20,41,58,60,61,67,106,107,116]. Standard colonoscopy preparations are made of nonabsorbable solutions such as Polyethylene glycol (PEG)electrolyte solutions (PEG-ELS) [117] that, because of the laxative action [20,60,67] and the large volume [118]-around 4 L-that must be ingested, can prevent the participants from completing the preparation [119].…”

“…Finally, with regards to the test attributes considered as the most important to participants, the available literature indicates that, in general, the "ideal" test would be a low-cost, non-invasive test that does not require sedation, does not require preparation, does not involve radiation, has a low probability of pain and complications, is characterized by a high accuracy and significant mortality reduction and is offered with less frequency [20,41,[58][59][60][61]67,88,107,109,115,124,152]. Although creating a test that could meet these expectations is certainly challenging, it appears clear that, in order to maximize uptake in CRC screening programs, efforts of the scientific community should point in this direction.…”