Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study

Lew, Jie-Bin; John, David; Xu, Xiang; Greuter, Marjolein J.E.; Caruana, Michael; Cenin, Dayna R.; He, Emily; Saville, Marion; Grogan, Paul; Coupé, Veerle M.H.; Canfell, Karen

doi:10.1016/s2468-2667(17)30105-6

Cited by 130 publications

(219 citation statements)

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“…17,26 Screen-detected colorectal cancer patients were assumed to have improved survival compared with patients whose cancer was symptomatically diagnosed at the same stage, consistent with data from international studies. The modelled cancer survival probabilities vary by cancer stage, time since cancer diagnosis and whether the cancer was diagnosed due to symptomatic detection or via screening.…”

Section: Policy1-bowel Model Platformsupporting

confidence: 60%

“…The model simulates both the adenoma-carcinoma pathway and the serrated pathway in colorectal cancer development, assuming 15% of colorectal cancers are attributable to the serrated pathway. 17 Briefly, the Policy1-Bowel model is constructed using Microsoft Visual Studio 2013 C11. 17 Detailed calibration and validation results for the Australian implementation have been described elsewhere.…”

Section: Policy1-bowel Model Platformmentioning

confidence: 99%

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Evaluation of the benefits, harms and cost‐effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia

Lew

John

Macrae

et al. 2018

Intl Journal of Cancer

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The Australian National Bowel Cancer Screening Program (NBCSP) will fully roll-out 2-yearly screening using the immunochemical Faecal Occult Blood Testing (iFOBT) in people aged 50 to 74 years by 2020. In this study, we aimed to estimate the comparative health benefits, harms, and cost-effectiveness of screening with iFOBT, versus other potential alternative or adjunctive technologies. A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate a total of 13 screening approaches involving use of iFOBT, colonoscopy, sigmoidoscopy, computed tomographic colonography (CTC), faecal DNA (fDNA) and plasma DNA (pDNA), in people aged 50 to 74 years. All strategies were evaluated in three scenarios: (i) perfect adherence, (ii) high (but imperfect) adherence, and (iii) low adherence. When assuming perfect adherence, the most effective strategies involved using iFOBT (annually, or biennially with/without adjunct sigmoidoscopy either at 50, or at 54, 64 and 74 years for individuals with negative iFOBT), or colonoscopy (10-yearly, or once-off at 50 years combined with biennial iFOBT). Colorectal cancer incidence (mortality) reductions for these strategies were 51-67(74-80)% in comparison with no screening; 2-yearly iFOBT screening (i.e. the NBCSP) would be associated with reductions of 51(74)%. Only 2-yearly iFOBT screening was found to be cost-effective in all scenarios in context of an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS); this strategy was associated with an incremental cost-effectiveness ratio of A$2,984/LYS-A$5,981/LYS (depending on adherence). The fully rolled-out NBCSP is highly cost-effective, and is also one of the most effective approaches for bowel cancer screening in Australia.

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Section: Policy1-bowel Model Platformsupporting

confidence: 60%

Section: Policy1-bowel Model Platformmentioning

confidence: 99%

Evaluation of the benefits, harms and cost‐effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia

Lew

John

Macrae

et al. 2018

Intl Journal of Cancer

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“…All the financial cost‐effectiveness modelling that has been reported regarding the NBCSP suggests that it will deliver substantial cost savings for the healthcare system if widely and efficiently implemented …”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, they are certain to exist and may be significant for society. Carer costs have not been included, for example family taking time off to transport and accompany patients to appointments. We have not valued the healthcare benefits of using the specialist consultations freed up by this process for other patients and indications. We have not valued the potential cost savings that might be made by earlier detection of disease resulting from the greater clinical efficacy of this process, which has been shown to reduce waiting times for colonoscopy. This has been done in the analysis of the NBCSP As experience with the system has grown, the indications for rejecting patients for telephone screening have been relaxed, so a greater proportion of referred patients have been booked by the process.…”

Section: Discussionmentioning

confidence: 99%

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Direct access colonoscopy service for bowel cancer screening produces a positive financial benefit for patients and local health districts

Clarke

Pockney

Gillies

et al. 2019

Internal Medicine Journal

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Background A direct access colonoscopy service (DACS) for the National Bowel Cancer Screening Program has become standard of care in Newcastle public hospitals because of the effect it has on time to colonoscopy. Cost‐effectiveness has not been studied to date. Aim The aim of this retrospective study was to analyse the cost‐effectiveness of a DACS. Methods Data were collected for patients referred to DACS between January 2014 and June 2016, and patients who were treated on the normal service pathway in 2013 prior to the introduction of the process. A cost‐benefit analysis from the patient’s and local health district’s perspective was undertaken. Results Introduction of the DACS produces a direct financial gain to patients in the form of reduced direct costs. It produces an indirect financial gain in terms of increased productivity if the patient is in work, and of increased leisure time if not in work. The DACS is modest income generating for the local health district, an evaluation which is sensitive to internal policies for distribution of government funding within a district. The DACS increases the availability of outpatient consultations to other patients, which is not a quantifiable economic benefit, but is likely to be an overall health benefit. Conclusion The introduction of DACS in the public system in Australia is of financial benefit to patients and to the local health service provider. It is likely to produce health benefits to non‐screening patients, by means of freeing consultations to be used for other indications.

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The death burden of colorectal cancer attributable to modifiable risk factors, trend analysis from 1990 to 2019 and future predictions

Zhu,

Zhang,

et al. 2024

Cancer Medicine

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BackgroundThe death burden attributable to modifiable risk factors is key to colorectal cancer (CRC) prevention. This study aimed to assess the prevalence and regional distribution of attributable CRC death burden worldwide from 1990 to 2019.MethodsWe extracted data from the Global Burden of Disease Study in 2019 and assessed the mortality, age‐standardized death rate (ASDR), population attributable fractions, and time trend in CRC attributable to risk factors by geography, socio‐demographic index (SDI) quintile, age, and sex.ResultsOver the past 30 years, from high to low SDI region, the number of deaths increased by 46.56%, 103.55%, 249.64%, 231.89%, 163.11%, and the average annual percentage change (AAPC) for ASDR were −1.06%, −0.01%, 1.32%, 1.19%, and 0.65%, respectively. ASDR in males was 1.88 times than in females in 2019; ASDR in males showed an increasing trend (AAPC 0.07%), whereas ASDR in females showed a decreasing trend (AAPC −0.69%) compared to figures in 1990. In 2019, from high to low SDI region, the 15–49 age group accounted for 3%, 6%, 10%, 11%, and 15% of the total population; dietary and metabolic factors contributed 43.4% and 20.8% to CRC‐attributable death worldwide. From high to low SDI region, ASDRs caused by dietary and metabolic factors increased by −23.4%, −5.5%, 25.8%, 29.1%, 13.5%, and 1.4%, 33.3%, 100.8%, 128.4%, 77.7% respectively, compared to 1990.ConclusionsThe attributable CRC death burden gradually shifted from higher SDI to lower SDI regions. The limitation in males was more significant, and the gap is expected to be further expanded. In lower SDI regions, the death burden tended to affect younger people. The leading cause of CRC‐attributable deaths was the inadequate control of dietary and metabolic risk factors.

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Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study

Abstract: Australia Postgraduate Award PhD Scholarship, Translational Cancer Research Network Top-up scholarship (supported by Cancer Institute NSW) and Cancer Council NSW.

Cited by 130 publications

References 21 publications

Evaluation of the benefits, harms and cost‐effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia

Evaluation of the benefits, harms and cost‐effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia

Direct access colonoscopy service for bowel cancer screening produces a positive financial benefit for patients and local health districts

The death burden of colorectal cancer attributable to modifiable risk factors, trend analysis from 1990 to 2019 and future predictions

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