Economic Evaluation of Fecal Occult Blood Test and Colonoscopy for Colorectal Cancer Screening in Indonesia: A Cost-Effectiveness Analysis

OBJECTIVE: to evaluate the cost-effectiveness of Fecal Occult Blood Test (FOBT) and colonoscopy as Colorectal Cancer (CRC) screening methods in Indonesia. It is hoped that the results will serve as a reference for developing an efficient and targeted early CRC screening policy. METHODS: A cost-effectiveness analysis comparing FOBT and colonoscopy for CRC screening in Indonesia was performed using a Markov model with a 40-year horizon. The analysis, from a healthcare payer perspective, included direct medical costs and QALYs. Parameters were sourced from literature and national data. Outcomes were lifetime costs, QALYs, and ICERs, with a willingness-to-pay threshold of three times GDP per capita. Costs and outcomes were discounted at 3%. Sensitivity analyses tested model uncertainty. Analyses were done using Microsoft® Excel. RESULT: CRC screening reduced both the incidence of colorectal cancer and CRC-related mortality compared to no screening. In terms of costs and outcomes, colonoscopy every 10 years produced the highest QALYs (2,114,459) and was the only strategy considered cost-effective compared to no screening, with an ICER of US$2,909.675/QALY, well below the willingness-to-pay threshold. While screening strategies incurred higher costs than no screening, colonoscopy was dominant when compared to both annual and biennial FOBT (ICERs: US$ -33,063.979/QALY and US$ -14,338.339/QALY, respectively). One-way sensitivity analysis identified cancer utility as key drivers of ICER variability. Probabilistic sensitivity analysis confirmed the robustness of the results, with the majority of simulations favoring colonoscopy as the most cost-effective option. CONCLUSION: Colonoscopy every 10 years is the most cost-effective strategy for colorectal cancer screening in Indonesia. It is cost-effective compared to no screening and dominant compared to annual or biennial FOBT.