A Cost-Effectiveness Analysis of Colorectal Cancer (CRC) Screening Modalities in Kuwait and Views of Primary Care Physicians and Patients on CRC

Background: CRC is the second most frequent cancer among men and women aner breast cancer in Kuwait. Colonoscopy is the most popular screening modality used in the governmental hospitals in Kuwait for the early detection of CRC. However, the FIT (Fecal Immunochemical Testing) and sigmoidoscopy are two additional popular CRC screening modalities. The primary purpose of this study is to assess the relative cost-effectiveness of the three major CRC screening modalities (colonoscopy, sigmoidoscopy, FIT) in Kuwait. If FIT is equal or superior in terms cost-effectiveness than colonoscopy and sigmoidoscopy in Kuwait, then FIT can be introduced as another first line screening modality to enhance the local efforts in decreasing the CRC burden in Kuwait. The secondary purpose is to assess the views of the Primary Care Physicians (PCPs) and patients on CRC screening modalities. Two research questions will be examined: "which among the three CRC screening modalities is the most effective one?" and "what are the beliefs Of the PCPs and patients on CRC screening"? The rationale for the study is that by identifying which screening modality is the most cost-effective one, the Ministry of Health (MOH) can use this information to decide whether FIT can be used as a first-tier screening modality which can save in the long-term costs associated with CRC since more people Will be reached for screening and thus identity more CRC cases at an early stage. The information derived by answering the second research question can be used to identify strategies to enhance the quality of the current CRC screening services. Methods: Data from 160 patients admitted for screening and treatment of the CRC Will be collected in Kuwait Cancer Control Centre (KCCC). Costing Template and Health Care Utilisation questionnaire will be used to collect costing data for analysis using a combination of step-down and activity-based costing methods. Quality of life will be assessed via the administration of the