Long-Term Prediction of the Demand of Colonoscopies Generated by a Population-Based Colorectal Cancer Screening Program

Abstract

ObjectiveTo estimate the long-term need for colonoscopies after a positive fecal immunochemical test (FIT) and post-polypectomy surveillance in the context of a population-based colorectal cancer (CRC) screening program.MethodsA discrete-event simulation model was built to reproduce the process of CRC screening and post-polypectomy surveillance following European guidelines in a population of 100,000 men and women aged 50–69 years over a 20-year period. Screening consisted of biennial FIT and colonoscopy in participants with positive results. The model was mainly fed using data from the first and second rounds of a Spanish program (2010–2013). Data on post-polypectomy surveillance results were obtained from the literature. A probabilistic multivariate sensitivity analysis was performed on the effect of participation, FIT positivity, and adherence to surveillance colonoscopies. The main outcome variables were the number of colonoscopies after a positive FIT, surveillance colonoscopies, and the overall number of colonoscopies.ResultsAn average yearly number of 1,200 colonoscopies after a positive FIT were predicted per 100,000 inhabitants with a slight increase to 1,400 at the end of the 20-year period. Surveillance colonoscopies increased to an average of 1,000 per 100,000 inhabitants in the long-term, showing certain stabilization in the last years of the 20-year simulation horizon. The results were highly sensitive to FIT positivity.ConclusionsImplementing a population-based CRC screening program will increase the demand for colonoscopies, which is expected to double in 20 years, mainly due to an increase in surveillance colonoscopies.

Global perspective on colonoscopy use for colorectal cancer screening: A multi-country survey of practicing colonoscopists

“…Over the last decade, a whole range of technologies have been introduced in clinical practice to diagnosed and treat colorectal cancer [5] , [6] , [7] , [8] . In term of screening, various non-invasive techniques, such as fecal occult blood tests (FOBT) and stool DNA tests (FIT-DNA) have been developed, as well as blood based tests [5] , [6] , [7] , [8] . The main advantage of these tests is their convenience for the patients which could improve colorectal cancer screening uptake.…”

National data analysis and systematic review for human resources for cervical cancer screening in Japan: Who should take Pap smears for cervical cancer screening?

“…In the U.S., most primary care physicians provide Pap tests to their patients following the speci ed guidelines [27]. However, although family and general physicians were more likely to follow the speci ed guidelines used by gynecologists [26], some nonexpert physicians feel that there are some barriers in accurately taking Pap smears, such as the lack of a training system [30]. Similar problems have been suggested in studies conducted in European countries [28,29,31].…”

“…However, in Japan, there has been insu cient discussion regarding the resources for cancer screening programs at the introduction of new techniques except for endoscopic screening for gastric cancer [20]. In the U.S. and European countries, the capacity of colonoscopy has been investigated since the introduction of colorectal cancer screening using fecal blood occult testing and total colonoscopy [21][22][23][24][25][26]. The required numbers were estimated based on the model when the participation rate increased in colorectal cancer screening [25,26].…”

“…In the U.S. and European countries, the capacity of colonoscopy has been investigated since the introduction of colorectal cancer screening using fecal blood occult testing and total colonoscopy [21][22][23][24][25][26]. The required numbers were estimated based on the model when the participation rate increased in colorectal cancer screening [25,26]. From the national survey in Japan, the number of gynecologists and obstetricians has not increased su ciently despite the increase in the number of all physicians.…”

Modeling Diseases: Prevention, Cure and Management

“…Models typically take a DES, SD or Markov Chain approach. Computer simulation has been used extensively within healthcare and interested readers can find models from mental health (Lebcir et al 2017;Thompson et al 2014;Cepoiu-Martin and Bischak 2017), cancer screening (Comas et al 2016;Jansen and Zoetelief 1997;Brailsford et al 2012), stroke (Monks et al 2017;Lahr et al 2017), diabetes (Chalk et al 2012;Davies et al 2000) and heart disease models (Vasilakis et al 2007;Mustafee et al 2012).…”