Willingness to Pay for Colorectal Cancer Screening and Effect of Copayment in Southern Thailand

Abstract

Background: The incidence rate of colorectal cancer in Thailand is increasing. Hence, the nationwide screening<br />programme with copayment is being considered. There are two proposed screening alternatives: annual fecal<br />immunochemical test (FIT) and once-in-10-year colonoscopy. A copayment for FIT is 60 Thai baht (THB) per test<br />(≈ 1.7 USD); a copayment for colonoscopy is 2,300 THB per test (≈ 65.5 USD). Methods: The willingness to pay<br />(WTP) technique, which is theoretically founded on a cost-benefit analysis, was used to assess an effect of copayment on<br />the uptake. Subjects were patients aged 50-69 years without cancer or screening experience. WTP for the proposed<br />tests was elicited. Results: Nearly two thirds of subjects were willing to pay for FIT. Less than half of subjects were<br />willing to pay for colonoscopy. Among them, median WTP for both tests was greater than the proposed copayments.<br />In a probit model, knowing CRC patient and presence of companion were associated with non-zero WTP for FIT.<br />Presence of companion, female, and family history of cancer were associated with non-zero WTP for colonoscopy.<br />After adjustment for starting price in the linear model, marital status, drinking behavior, and risk attitude were associated<br />with WTP. None of factors was significant for colonoscopy. Uptake decreased as levels of copayment increased.<br />At proposed copayments, the uptake rates of 59.8% and 21.6% were estimated for colonoscopy and FIT respectively.<br />The demand for FIT was price inelastic; the demand for colonoscopy was price elastic. Estimates of optimal copayment<br />were 62.1 THB for FIT and 460.2 THB for colonoscopy. At the optimal copayment, uptake rates would be 59.8%<br />for FIT and 42.3% for colonoscopy.Conclusion(s): More subjects were willing to pay for FIT than for colonoscopy<br />(59.0% versus 46.5%). The estimated uptake rates were 59.8% and 21.6% for colonoscopy and FIT at the proposed<br />copayments.