Reappraisal of the options for colorectal cancer screening in England

Whyte, Sophie; Chilcott, Jim; Halloran, Stephen P

doi:10.1111/j.1463-1318.2012.03014.x

Cited by 44 publications

(108 citation statements)

References 17 publications

(27 reference statements)

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“…To that end, a model was developed to assess the total resource implications and health impacts of screening by simulating the natural history of CRC and the impact of screening on that natural history (Tappenden et al, 2007). This model was later refined and updated to reflect data emerging from the BCSP (Whyte et al, 2012;Whyte et al, 2011). In this paper, we build on the latest version of this economic evaluation model and use it to estimate the distribution of health associated with alternative screening strategies.…”

Section: Introductionmentioning

confidence: 99%

Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme

et al. 2014

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This paper presents an application of a new methodological framework for undertaking distributional cost-effectiveness analysis to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The National Health Service bowel cancer screening programme introduced in 2006 is expected to improve population health on average and to worsen population health inequalities associated with deprivation and ethnicity -a classic case of 'intervention-generated inequality'. We demonstrate the distributional cost-effectiveness analysis framework by examining two redesign options for the bowel cancer screening programme: (i) the introduction of an enhanced targeted reminder aimed at increasing screening uptake in deprived and ethnically diverse neighbourhoods and (ii) the introduction of a basic universal reminder aimed at increasing screening uptake across the whole population. Our analysis indicates that the universal reminder is the strategy that maximises population health, while the targeted reminder is the screening strategy that minimises unfair variation in health. The framework is used to demonstrate how these two objectives can be traded off against each other, and how alternative social value judgements influence the assessment of which strategy is best, including judgements about which dimensions of health variation are considered unfair and judgements about societal levels of inequality aversion.

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Section: Introductionmentioning

confidence: 99%

Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme

et al. 2014

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“…The model assumes that neither the prior detection of adenomas nor the incidence of complications following colonoscopy impacts on HRQoL; this is consistent with previous economic models of CRC screening. [85][86][87] In addition, the base-case analysis of the model assumes that different health utilities are applied at the point of development of CRC. It is possible, however, that a patient's HRQoL would be affected by the diagnosis of clinical cancer rather than the development of preclinical disease.…”

Section: Health-economic Evaluation Of Alternative Surveillance Stratmentioning

confidence: 99%

“…The costs of colonoscopy and associated complications were taken from NHS Reference Costs 2012-13. 93 Estimates of the lifetime costs of diagnosis and management of CRC were taken from a previous modelling study reported by Whyte et al 86 and adjusted according to the stage distribution reported in the 2011 report of the NBOCAP.…”

Section: Health-economic Evaluation Of Alternative Surveillance Stratmentioning

confidence: 99%

The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

Atkin

Brenner

Martin

et al. 2017

Health Technol Assess

131

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This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 04/33/01. The contractual start date was in September 2006. The draft report began editorial review in March 2015 and was accepted for publication in December 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Published by...

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“…Long-term costs and QALY outcomes at the end points of the decision tree were estimated from an existing model, that is, the School of Health and Related Research's bowel cancer screening (SBCS) model, developed by Whyte and colleagues. 122 We chose to use the SBCS model, rather than to develop a new one, because it is a long-standing model that has been validated, and which was used to inform the introduction of the National Bowel Cancer Screening Programme. The SBCS model was adapted for this current assessment, with updated parameters where possible.…”

Section: Model Structurementioning

confidence: 99%

“…The SBCS model 122 describes the development of adenomas and colorectal cancer and subsequent disease progression for the general population of England eligible for bowel cancer screening. It was developed by the School of Health and Related Research for the NHS Bowel Cancer Screening Programme.…”

Section: The School Of Health and Related Research's Bowel Cancer Scrmentioning

confidence: 99%

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Picot

Rose

Cooper

et al. 2017

Health Technol Assess

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BackgroundCurrent clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification.DesignSystematic review and economic analysis.ParticipantsPeople undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer.InterventionsNBI, FICE and i-scan.Main outcome measuresDiagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology.Data sourcesElectronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence.Review methodsSystematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost–utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research’s bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy.ResultsThirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan.LimitationsLimited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps.ConclusionsVCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training.Future workFuture research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality.Study registrationThis study is registered as PROSPERO CRD42016037767.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Reappraisal of the options for colorectal cancer screening in England

Cited by 44 publications

References 17 publications

Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme

Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme

The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

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