Jie-Bin Lew1, D James B St John2, Xiang-Ming Xu3, Marjolein J E Greuter4, Michael Caruana5, Dayna R Cenin6, Emily He5, Marion Saville7, Paul Grogan8, Veerle M H Coupé4, Karen Canfell9. 1. Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia. Electronic address: jiebin.lew@nswcc.org.au. 2. Prevention Division, Cancer Council Victoria, VIC, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC, Australia. 3. Prince of Wales Clinical School, University of NSW, NSW, Australia. 4. Epidemiology and Biostatistics, VU Medical Center, Boelelaan, Amsterdam, Netherlands. 5. Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia. 6. Faculty of Health Sciences, Curtin University, WA, Australia; Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands. 7. Victorian Cytology Service Ltd, Carlton South, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia. 8. Advocacy, Cancer Council Australia, Sydney, NSW, Australia. 9. Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia.
Abstract
BACKGROUND: No assessment of the National Bowel Screening Program (NBCSP) in Australia, which considers all downstream benefits, costs, and harms, has been done. We aimed to use a comprehensive natural history model and the most recent information about cancer treatment costs to estimate long-term benefits, costs, and harms of the NBCSP (2 yearly immunochemical faecal occult blood testing screening at age 50-74 years) and evaluate the incremental effect of improved screening participation under different scenarios. METHODS: In this modelling study, a microsimulation model, Policy1-Bowel, which simulates the development of colorectal cancer via both the conventional adenoma-carcinoma and serrated pathways was used to simulate the NBCSP in 2006-40, taking into account the gradual rollout of NBCSP in 2006-20. The base-case scenario assumed 40% screening participation (currently observed behaviour) and two alternative scenarios assuming 50% and 60% participation by 2020 were modelled. Aggregate year-by-year screening, diagnosis, treatment and surveillance-related costs, resource utilisation (number of screening tests and colonoscopies), and health outcomes (incident colorectal cancer cases and colorectal cancer deaths) were estimated, as was the cost-effectiveness of the NBCSP. FINDINGS: With current levels of participation (40%), the NBCSP is expected to prevent 92 200 cancer cases and 59 000 deaths over the period 2015-40; an additional 24 300 and 37 300 cases and 16 800 and 24 800 deaths would be prevented if participation was increased to 50% and 60%, respectively. In 2020, an estimated 101 000 programme-related colonoscopies will be done, associated with about 270 adverse events; an additional 32 500 and 49 800 colonoscopies and 88 and 134 adverse events would occur if participation was increased to 50% and 60%, respectively. The overall number needed to screen (NNS) is 647-788 per death prevented, with 52-59 colonoscopies per death prevented. The programme is cost-effective due to the cancer treatment costs averted (cost-effectiveness ratio compared with no screening at current participation, AUS$3014 [95% uncertainty interval 1807-5583] per life-year saved) in the cost-effectiveness analysis. In the budget impact analysis, reduced annual expenditure on colorectal cancer control is expected by 2030, with expenditure reduced by a cumulative AUS$1·7 billion, AUS$2·0 billion, and AUS$2·1 billion (2015 prices) between 2030 and 2040, at participation rates of 40%, 50%, and 60%, respectively. INTERPRETATION: The NBCSP has potential to save 83 800 lives over the period 2015-40 if coverage rates can be increased to 60%. By contrast, the associated harms, although an important consideration, are at a smaller magnitude at the population level. The programme is highly cost-effective and within a decade of full roll-out, there will be reduced annual health systems expenditure on colorectal cancer control due to the impact of screening. FUNDING: Australia Postgraduate Award PhD Scholarship, Translational Cancer Research Network Top-up scholarship (supported by Cancer Institute NSW) and Cancer Council NSW.
BACKGROUND: No assessment of the National Bowel Screening Program (NBCSP) in Australia, which considers all downstream benefits, costs, and harms, has been done. We aimed to use a comprehensive natural history model and the most recent information about cancer treatment costs to estimate long-term benefits, costs, and harms of the NBCSP (2 yearly immunochemical faecal occult blood testing screening at age 50-74 years) and evaluate the incremental effect of improved screening participation under different scenarios. METHODS: In this modelling study, a microsimulation model, Policy1-Bowel, which simulates the development of colorectal cancer via both the conventional adenoma-carcinoma and serrated pathways was used to simulate the NBCSP in 2006-40, taking into account the gradual rollout of NBCSP in 2006-20. The base-case scenario assumed 40% screening participation (currently observed behaviour) and two alternative scenarios assuming 50% and 60% participation by 2020 were modelled. Aggregate year-by-year screening, diagnosis, treatment and surveillance-related costs, resource utilisation (number of screening tests and colonoscopies), and health outcomes (incident colorectal cancer cases and colorectal cancer deaths) were estimated, as was the cost-effectiveness of the NBCSP. FINDINGS: With current levels of participation (40%), the NBCSP is expected to prevent 92 200 cancer cases and 59 000 deaths over the period 2015-40; an additional 24 300 and 37 300 cases and 16 800 and 24 800 deaths would be prevented if participation was increased to 50% and 60%, respectively. In 2020, an estimated 101 000 programme-related colonoscopies will be done, associated with about 270 adverse events; an additional 32 500 and 49 800 colonoscopies and 88 and 134 adverse events would occur if participation was increased to 50% and 60%, respectively. The overall number needed to screen (NNS) is 647-788 per death prevented, with 52-59 colonoscopies per death prevented. The programme is cost-effective due to the cancer treatment costs averted (cost-effectiveness ratio compared with no screening at current participation, AUS$3014 [95% uncertainty interval 1807-5583] per life-year saved) in the cost-effectiveness analysis. In the budget impact analysis, reduced annual expenditure on colorectal cancer control is expected by 2030, with expenditure reduced by a cumulative AUS$1·7 billion, AUS$2·0 billion, and AUS$2·1 billion (2015 prices) between 2030 and 2040, at participation rates of 40%, 50%, and 60%, respectively. INTERPRETATION: The NBCSP has potential to save 83 800 lives over the period 2015-40 if coverage rates can be increased to 60%. By contrast, the associated harms, although an important consideration, are at a smaller magnitude at the population level. The programme is highly cost-effective and within a decade of full roll-out, there will be reduced annual health systems expenditure on colorectal cancer control due to the impact of screening. FUNDING: Australia Postgraduate Award PhD Scholarship, Translational Cancer Research Network Top-up scholarship (supported by Cancer Institute NSW) and Cancer Council NSW.
Authors: Charles Cock; Shahzaib Anwar; Susan E Byrne; Rosie Meng; Susanne Pedersen; Robert J L Fraser; Graeme P Young; Erin L Symonds Journal: Dig Dis Sci Date: 2019-03-05 Impact factor: 3.199
Authors: Mary Dillon; Louisa Flander; Daniel D Buchanan; Finlay A Macrae; Jon D Emery; Ingrid M Winship; Alex Boussioutas; Graham G Giles; John L Hopper; Mark A Jenkins; Driss Ait Ouakrim Journal: PLoS Med Date: 2018-08-16 Impact factor: 11.069
Authors: Eleonora Feletto; Jie-Bin Lew; Joachim Worthington; Emily He; Michael Caruana; Katherine Butler; Harriet Hui; Natalie Taylor; Emily Banks; Karen Barclay; Kate Broun; Alison Butt; Rob Carter; Jeff Cuff; Anita Dessaix; Hooi Ee; Jon Emery; Ian M Frayling; Paul Grogan; Carol Holden; Christopher Horn; Mark A Jenkins; James G Kench; Maarit A Laaksonen; Barbara Leggett; Gillian Mitchell; Susan Morris; Bonny Parkinson; D James St John; Linda Taoube; Katherine Tucker; Melanie A Wakefield; Robyn L Ward; Aung Ko Win; Daniel L Worthley; Bruce K Armstrong; Finlay A Macrae; Karen Canfell Journal: BMJ Open Date: 2020-06-21 Impact factor: 2.692
Authors: Joachim Worthington; Jie-Bin Lew; Eleonora Feletto; Carol A Holden; Daniel L Worthley; Caroline Miller; Karen Canfell Journal: PLoS One Date: 2020-02-03 Impact factor: 3.240