Centre for Public Health, Queen's University Belfast, Belfast, UK
Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.
BMJ Open. 2023 Mar 21;13(3):e066925. doi: 10.1136/bmjopen-2022-066925.
The 2020-2022 research project 'Colorectal Cancer Screening Intervention for Malaysia' (CRC-SIM) evaluated the implementation of a home-based CRC screening pilot in Segamat District. This budget impact analysis (BIA) assessed the expected changes in health expenditure of the Malaysian Ministry of Health budget in the scenario where the pilot programme was implemented nationwide vs current opportunistic screening.
Budget impact analysis. Assumptions and costs in the opportunistic and novel CRC screening scenarios were derived from a previous evaluation of opportunistic CRC screening in community health clinics across Malaysia and the CRC-SIM research project, respectively.
National level (with supplement analysis for district level). The BIA was conducted from the viewpoint of the federal government and estimated the annual financial impact over a period of 5 years.
The total annual cost of the current practice of opportunistic screening was RM1 584 321 (I$1 099 460) of which 80% (RM1 274 690 or ~I$884 587) was expended on the provision of opportunistic CRC to adults who availed of the service. Regarding the implementation of national CRC screening programme, the net budget impact in the first year was estimated to be RM107 631 959 (I$74 692 546) and to reach RM148 485 812 (~I$103 043 589) in the fifth year based on an assumed increased uptake of 5% annually. The costs were calculated to be sensitive to the probability of adults who were contactable, eligible and agreeable to participating in the programme.
Results from the BIA provided direct and explicit estimates of the budget changes to when implementing a population-based national CRC screening programme to aid decision making by health services planners and commissioners in Malaysia about whether such programme is affordable within given their budget constraint. The study also illustrates the use and value of the BIA approach in low-income and middle-income countries and resource-constrained settings.
2020-2022 年的研究项目“马来西亚结直肠癌筛查干预（CRC-SIM）”评估了在塞格马特区开展基于家庭的结直肠癌筛查试点的实施情况。本预算影响分析（BIA）评估了在全国范围内实施试点项目与当前机会性筛查相比，马来西亚卫生部预算的卫生支出预计会发生的变化。
预算影响分析。机会性和新型 CRC 筛查情景下的假设和成本分别来自之前对马来西亚社区卫生诊所机会性 CRC 筛查的评估和 CRC-SIM 研究项目。
国家级（补充分析为区级）。该 BIA 从联邦政府的角度进行，估计了在 5 年内的年度财务影响。
目前机会性筛查实践的总成本为 158.4321 令吉（109.9460 美元），其中 80%（127.4690 令吉或88.4587 美元）用于为接受该服务的成年人提供机会性 CRC。关于实施全国性 CRC 筛查计划，第一年的净预算影响估计为 10763.1959 令吉（7469.2546 美元），并假设每年接受率增加 5%，第五年达到 14848.5812 令吉（10304.3589 美元）。这些成本对接触到的成年人、符合条件和同意参与该计划的成年人的概率敏感。
BIA 的结果提供了实施基于人群的全国性 CRC 筛查计划对预算变化的直接和明确估计，以帮助马来西亚卫生服务规划者和管理者做出决策，了解在给定预算限制内是否可以负担得起该计划。该研究还说明了 BIA 方法在低收入和中等收入国家和资源有限的环境中的使用和价值。
