Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2018; 24(41): 4708-4715
Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4708
Willingness to pay for colorectal cancer screening in Guangzhou
Qin Zhou, Yan Li, Hua-Zhang Liu, Ying-Ru Liang, Guo-Zhen Lin
Qin Zhou, Yan Li, Hua-Zhang Liu, Ying-Ru Liang, Guo-Zhen Lin, Department of Non-communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong Province, China
Author contributions: Zhou Q, Li Y, Liu HZ, and Lin GZ conceived of and designed the study; Zhou Q and Liang YR performed the data collection, statistical analyses, and data interpretation; Zhou Q drafted the manuscript; all authors read and approved the final manuscript.
Supported by the Natural Science Foundation of Guangdong Province, No. 2016A030313504; and Guangzhou Science and Technology Program Key Project, No. 201707010205.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Guangzhou Center of Disease Control and Prevention.
Informed consent statement: Written informed consent to participate in the study was obtained from all participants.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: We declare that the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qin Zhou, MD, Occupational Physician, Research Scientist, Staff Physician, Statistical Worker, Technician, Department of Non-communicable Chronic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1, Qide Road, Baiyun district, Guangzhou 510440, Guangdong Province, China. zhouq@gzcdc.org.cn
Telephone: +86-20-36055856 Fax: +86-20-37431722
Received: July 23, 2018
Peer-review started: July 23, 2018
First decision: August 27, 2018
Revised: September 1, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: November 7, 2018
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer was the third most commonly diagnosed cancer in males and the second in females worldwide. And colorectal cancer screening could improve the early diagnosis rate and decrease the mortality of colorectal cancer. However, the compliance of screening was lower than 20%. And the uptake of colonoscopy in areas with free colonoscopy was higher than that in charged colonoscopy area. For mass screening program, it was not possible to be free of charge. Accordingly, the study of willingness to pay for colorectal cancer screening was very important.

Research motivation

Because previous studies of willingness to pay for colorectal cancer are few in China, the study of willingness to pay for colorectal cancer screening is very important for further health economics evaluation. The main topics of our study were to measure willingness to pay for colorectal cancer screening in Guangzhou, and to identify those factors associated.

Research objectives

The objective of our study was to figure out the willingness to pay for colorectal cancer screening, and to analyze those factors associated. This is very important for improving the uptake of colorectal cancer and developing screening strategies for the government

Research methods

A total of 1243 participants who took part in the prescreening of colorectal cancer in Guangzhou were collected in the study. A face-to-face questionnaire survey for pre-screening population from free and non-free colonoscopy districts was used to collect information on demographic characteristics, health behaviours, the intention of the cancer screenings and willingness to pay for colorectal cancer screening. A total of 1240 respondents were included in the analysis. The willingness to pay for colorectal cancer screening and the factors associated with it were evaluated.

Research results

The portion of willingness to pay for colorectal cancer screening in Guangzhou was 91.7%. “Unnecessary” was the dominant reason of unwillingness, accounting for 63.1%. There were 29.2%, 20.7%, 14.8%,13.0% and 22.4% of participants who were willing to pay less than ¥100, ¥100-¥199, ¥200-¥299, ¥300-¥399 and more than ¥400, respectively. Non-logistic regression analysis showed that respondents of male, with a high level of education, from the family with more raised persons, and accepting colorectal cancer screening were willing to pay for colorectal cancer screening. Multi-class logistic regression analysis showed that respondents with higher annual household income per capita, from government and private enterprises, government agency/institution and peasants, and with less family medical expenditure were willing to pay more.

Research conclusions

The study has concluded that willingness to pay for colorectal cancer screening in Guangzhou was high, but the amount of willing to pay was low, and less than the cost of colonoscopy. In order to move forward the population-base screening, it was necessary to strengthen publicity, increase awareness of screening, raise the budget of screening program for government and bring the colorectal cancer screening into outpatient medical insurance system.

Research perspectives

In this study, the respondents were from the population taking part in colorectal cancer primary screening. The representative of the sample was not very good, and the amount of willing to pay was semi-quantitative. It may influence the quantitative assessment. These need to be improved in the later research, measure the quantitative value of willingness to pay for Chinese, and improve parameters for health economics evaluation of colorectal cancer screening.