Benefits, harms and cost-effectiveness of potential age-extensions to the National Bowel Cancer Screening Program in Australia

Jie-Bin Lew, D James B St John, Finlay A Macrae, Jon D Emery, Hooi C Ee, Mark A Jenkins, Emily He, Paul Grogan, Michael Caruana, Marjolein Je Greuter, Veerle M H Coupe, Karen Canfell

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: The Australian National Bowel Cancer Screening Program(NBCSP) is rolling out 2-yearly immunochemical Faecal Occult Blood Test screening in people 50-74 years. This study aimed to evaluate the benefits, harms and cost-effectiveness of extending the NBCSP to younger and/or older ages.

METHODS: A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate the fully rolled-out NBCSP and alternative strategies assuming screening starts at 45 or 40 years and/or ceases at 79 or 84 years given three scenarios:(i) perfect adherence(100%), (ii) high adherence(60%), and (ii) low adherence(40%, as currently achieved).

RESULTS: The current NBCSP will reduce colorectal cancer incidence(mortality) by 23-51(36-74)% compared to no screening (range reflects participation); extending screening to younger or older ages would result in additional reductions of 2-6(2-9) or 1-3(3-7) percentage points, respectively. With an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS), only screening from 50-74 (incremental cost-effective ratio [ICER]:A$2,984-5,981/LYS) or from 45-74 (ICER:A$17,053-29,512/LYS) remained cost-effective in all participation scenarios. The number-needed-to-colonoscope to prevent a death over the lifetime of a cohort in the current NBCSP is 35-49. Starting at 45 years would increase colonoscopy demand for program-related colonoscopies by 3-14% and be associated with 55-170 additional colonoscopies per additional death prevented.

CONCLUSIONS: Starting screening at 45 years could be cost-effective, but it would increase colonoscopy demand and would be associated with a less favourable incremental benefits-to-harms trade-off than screening from 50-74 years.

IMPACT: The study underpins recently updated Australian colorectal cancer management guidelines which recommends that the NBCSP continues to offer bowel screening from 50-74 years.

Original languageEnglish
Pages (from-to)1450-1461
Number of pages12
JournalCancer Epidemiology Biomarkers and Prevention
Volume27
Issue number12
Early online date6 Sep 2018
DOIs
Publication statusPublished - 1 Dec 2018

Cite this

Lew, Jie-Bin ; St John, D James B ; Macrae, Finlay A ; Emery, Jon D ; Ee, Hooi C ; Jenkins, Mark A ; He, Emily ; Grogan, Paul ; Caruana, Michael ; Greuter, Marjolein Je ; Coupe, Veerle M H ; Canfell, Karen. / Benefits, harms and cost-effectiveness of potential age-extensions to the National Bowel Cancer Screening Program in Australia. In: Cancer Epidemiology Biomarkers and Prevention. 2018 ; Vol. 27, No. 12. pp. 1450-1461.
@article{adc02b32b2df4044b6e393ef7d815236,
title = "Benefits, harms and cost-effectiveness of potential age-extensions to the National Bowel Cancer Screening Program in Australia",
abstract = "BACKGROUND: The Australian National Bowel Cancer Screening Program(NBCSP) is rolling out 2-yearly immunochemical Faecal Occult Blood Test screening in people 50-74 years. This study aimed to evaluate the benefits, harms and cost-effectiveness of extending the NBCSP to younger and/or older ages.METHODS: A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate the fully rolled-out NBCSP and alternative strategies assuming screening starts at 45 or 40 years and/or ceases at 79 or 84 years given three scenarios:(i) perfect adherence(100{\%}), (ii) high adherence(60{\%}), and (ii) low adherence(40{\%}, as currently achieved).RESULTS: The current NBCSP will reduce colorectal cancer incidence(mortality) by 23-51(36-74){\%} compared to no screening (range reflects participation); extending screening to younger or older ages would result in additional reductions of 2-6(2-9) or 1-3(3-7) percentage points, respectively. With an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS), only screening from 50-74 (incremental cost-effective ratio [ICER]:A$2,984-5,981/LYS) or from 45-74 (ICER:A$17,053-29,512/LYS) remained cost-effective in all participation scenarios. The number-needed-to-colonoscope to prevent a death over the lifetime of a cohort in the current NBCSP is 35-49. Starting at 45 years would increase colonoscopy demand for program-related colonoscopies by 3-14{\%} and be associated with 55-170 additional colonoscopies per additional death prevented.CONCLUSIONS: Starting screening at 45 years could be cost-effective, but it would increase colonoscopy demand and would be associated with a less favourable incremental benefits-to-harms trade-off than screening from 50-74 years.IMPACT: The study underpins recently updated Australian colorectal cancer management guidelines which recommends that the NBCSP continues to offer bowel screening from 50-74 years.",
author = "Jie-Bin Lew and {St John}, {D James B} and Macrae, {Finlay A} and Emery, {Jon D} and Ee, {Hooi C} and Jenkins, {Mark A} and Emily He and Paul Grogan and Michael Caruana and Greuter, {Marjolein Je} and Coupe, {Veerle M H} and Karen Canfell",
note = "Copyright {\circledC}2018, American Association for Cancer Research.",
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Benefits, harms and cost-effectiveness of potential age-extensions to the National Bowel Cancer Screening Program in Australia. / Lew, Jie-Bin; St John, D James B; Macrae, Finlay A; Emery, Jon D; Ee, Hooi C; Jenkins, Mark A; He, Emily; Grogan, Paul; Caruana, Michael; Greuter, Marjolein Je; Coupe, Veerle M H; Canfell, Karen.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 27, No. 12, 01.12.2018, p. 1450-1461.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Benefits, harms and cost-effectiveness of potential age-extensions to the National Bowel Cancer Screening Program in Australia

AU - Lew, Jie-Bin

AU - St John, D James B

AU - Macrae, Finlay A

AU - Emery, Jon D

AU - Ee, Hooi C

AU - Jenkins, Mark A

AU - He, Emily

AU - Grogan, Paul

AU - Caruana, Michael

AU - Greuter, Marjolein Je

AU - Coupe, Veerle M H

AU - Canfell, Karen

N1 - Copyright ©2018, American Association for Cancer Research.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - BACKGROUND: The Australian National Bowel Cancer Screening Program(NBCSP) is rolling out 2-yearly immunochemical Faecal Occult Blood Test screening in people 50-74 years. This study aimed to evaluate the benefits, harms and cost-effectiveness of extending the NBCSP to younger and/or older ages.METHODS: A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate the fully rolled-out NBCSP and alternative strategies assuming screening starts at 45 or 40 years and/or ceases at 79 or 84 years given three scenarios:(i) perfect adherence(100%), (ii) high adherence(60%), and (ii) low adherence(40%, as currently achieved).RESULTS: The current NBCSP will reduce colorectal cancer incidence(mortality) by 23-51(36-74)% compared to no screening (range reflects participation); extending screening to younger or older ages would result in additional reductions of 2-6(2-9) or 1-3(3-7) percentage points, respectively. With an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS), only screening from 50-74 (incremental cost-effective ratio [ICER]:A$2,984-5,981/LYS) or from 45-74 (ICER:A$17,053-29,512/LYS) remained cost-effective in all participation scenarios. The number-needed-to-colonoscope to prevent a death over the lifetime of a cohort in the current NBCSP is 35-49. Starting at 45 years would increase colonoscopy demand for program-related colonoscopies by 3-14% and be associated with 55-170 additional colonoscopies per additional death prevented.CONCLUSIONS: Starting screening at 45 years could be cost-effective, but it would increase colonoscopy demand and would be associated with a less favourable incremental benefits-to-harms trade-off than screening from 50-74 years.IMPACT: The study underpins recently updated Australian colorectal cancer management guidelines which recommends that the NBCSP continues to offer bowel screening from 50-74 years.

AB - BACKGROUND: The Australian National Bowel Cancer Screening Program(NBCSP) is rolling out 2-yearly immunochemical Faecal Occult Blood Test screening in people 50-74 years. This study aimed to evaluate the benefits, harms and cost-effectiveness of extending the NBCSP to younger and/or older ages.METHODS: A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate the fully rolled-out NBCSP and alternative strategies assuming screening starts at 45 or 40 years and/or ceases at 79 or 84 years given three scenarios:(i) perfect adherence(100%), (ii) high adherence(60%), and (ii) low adherence(40%, as currently achieved).RESULTS: The current NBCSP will reduce colorectal cancer incidence(mortality) by 23-51(36-74)% compared to no screening (range reflects participation); extending screening to younger or older ages would result in additional reductions of 2-6(2-9) or 1-3(3-7) percentage points, respectively. With an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS), only screening from 50-74 (incremental cost-effective ratio [ICER]:A$2,984-5,981/LYS) or from 45-74 (ICER:A$17,053-29,512/LYS) remained cost-effective in all participation scenarios. The number-needed-to-colonoscope to prevent a death over the lifetime of a cohort in the current NBCSP is 35-49. Starting at 45 years would increase colonoscopy demand for program-related colonoscopies by 3-14% and be associated with 55-170 additional colonoscopies per additional death prevented.CONCLUSIONS: Starting screening at 45 years could be cost-effective, but it would increase colonoscopy demand and would be associated with a less favourable incremental benefits-to-harms trade-off than screening from 50-74 years.IMPACT: The study underpins recently updated Australian colorectal cancer management guidelines which recommends that the NBCSP continues to offer bowel screening from 50-74 years.

U2 - 10.1158/1055-9965.EPI-18-0128

DO - 10.1158/1055-9965.EPI-18-0128

M3 - Article

VL - 27

SP - 1450

EP - 1461

JO - Cancer Epidemiology Biomarkers and Prevention

JF - Cancer Epidemiology Biomarkers and Prevention

SN - 1055-9965

IS - 12

ER -