Colorectal cancer screening within colonoscopy capacity constraints: can FIT-based programmes save more lives by trading-off more sensitive test cut-offs against longer screening intervals?

Abstract

IntroductionColorectal cancer (CRC) prevention programmes using faecal immunochemical testing (FIT) as the primary screen typically rely on colonoscopy for secondary and surveillance testing. Colonoscopy capacity is an important constraint, limiting the number of primary tests offered. Many European programmes lack sufficient colonoscopy capacity to provide optimal screening intensity regarding screening age ranges, intervals and FIT cut-offs. It is currently unclear how to optimise programmes within colonoscopy capacity constraints.DesignThe MISCAN-Colon microsimulation model was used to determine if more effective CRC screening programmes can be identified within existing colonoscopy capacity. The model assessed 525 strategies of varying screening intervals, age ranges and FIT cut-offs, including previously unevaluated 4 and 5 year screening intervals. These strategies were compared with policy decisions taken in Ireland to provide CRC screening within available colonoscopy capacity. Outcomes estimated net costs, quality-adjusted-life-years and required colonoscopy numbers. The optimal strategies within finite colonoscopy capacity constraints were identified.ResultsCombining a reduced FIT cut-off of 10 µg Hb/g, an extended screening interval of 4 years and an age range of 60-72 years requires 6% fewer colonoscopies, reduces net costs by 23% while preventing 15% more CRC deaths and saving 16% more QALYs relative to current policy.ConclusionPreviously overlooked longer screening intervals may balance optimal cancer prevention with finite colonoscopy capacity constraints. Simple changes to screening configurations could save lives, reduce costs, and relieve colonoscopy capacity pressures. These findings are directly relevant to CRC screening programmes across Europe that employ FIT-based testing and face colonoscopy capacity constraints.

Cost consequences of unscheduled emergency admissions in cancer patients in the last year of life

“…Concerningly, patients with colorectal cancers were the second-highest users of UEC, costing more than £3 million; efforts to redistribute stage and refine outcomes for this group should be priority policy decisions. In light of the significant morbidity and mortality in this disease [ 33 ], where there are existing screening programmes for early diagnosis, expanded access to the screening process with more effective disease detection testing thresholds might improve patient outcomes [ 34 ] and prompt reductions in UEC.…”

Cost consequences of unscheduled emergency admissions in cancer patients in the last year of life

“…Concerningly, patients with colorectal cancers were the second-highest users of UEC, costing more than £3 million; efforts to redistribute stage and re ne outcomes for this group should be priority policy decisions. In light of the signi cant morbidity and mortality in this disease 33 , where there are existing screening programmes for early diagnosis, expanded access to the screening process, with more effective disease detection testing thresholds might improve patient outcomes 34 and prompt reductions in UEC.…”

Rastreo poblacional del cáncer colo-rectal en la provincia del Neuquén

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