Colonoscopy colorectal cancer screening: Cost-effectiveness in Thailand.

Dear Editor,

Colorectal cancer is a common malignancy worldwide. In Thailand, this cancer is one of the leading cancerous diseases. It is the third-and fifth-most common cancer in Thai males and females, respectively. To screen for this cancer becomes an issue in public health. Thanapirom et al. noted that “patient ignorance”, “unavailability of the test”, “unawareness of physicians,” and “financial problems” were four most important barriers for colorectal cancer screening in Thailand.[1] It is no doubt that the cost is the big issue for discussion in evaluation of any colorectal screening program. Screening colonoscopy is the screening technique that is presently available for colorectal cancer screening in Thailand and this technique has been used in many hospitals for a few years. The screening colonoscopy in Thailand is usually performed without occult blood test prescreening. This is due to the fact that this alternative, without prescreening, is more proper in term of medical economics.[2] However, there has never been a systematic evaluation on the cost-effectiveness of colonoscopy colorectal cancer screening in population scale. According to the recent report by Aswakul et al.,[3] the detection rate of colorectal cancer by colonoscopy screening is equal to 0.6%. The remained query is on the cost-effectiveness of the colonoscopy colorectal cancer screening. Using a simple cost-effectiveness analysis, the cost-effectiveness can hereby calculated by “cost-effectiveness = cost/effectiveness”. In this work, cost is assigned to be the cost according to the referencing hospital charge in baht. The referencing charge is equal to 6000 baht (estimated 200 USD). Whereas effectiveness is assigned to be the detection rate, which is already mentioned in the reference paper by Aswakul et al.[3] Hence, the cost-effectiveness is hereby equal to 1,000,000 baht per diagnosis of colorectal cancer. This amount is considerable high and the cost of the test can be the obstacle for generalization of screening. How to reduce the cost is the question to be answered in further policies research.