How Ireland's Colorectal Screening Programme Could Save More Lives, Save Money And Stay Within Existing Colonoscopy Capacity Limits: Evidence From The MISCAN Microsimulation Model

Description

Background
Ireland’s colorectal cancer screening programme, ‘BowelScreen,’ currently offers biennial faecal immunochemical testing (FIT) for 60-69 year-olds, using a test positivity cut-off of 225ng/ml of haemoglobin. FIT can be adjusted by varying positivity cut-off which alters the screening sensitivity and specificity. The choice of FIT has implications for the number of cancers detected and the colonoscopy capacity required for screening triage and subsequent surveillance. Existing literature indicates that screening programmes using a lower cut-off of 50ng/ml would cost less and be more effective, but may require more colonoscopy capacity for positive screen findings. Ireland’s current colonoscopy capacity has been a binding constraint on ‘BowelScreen’ and the current screening age range is shorter than initially planned due to this limitation. The objective of this study was to determine if a more effective, less costly screening strategy exists within BowelScreen’s current colonoscopy capacity by considering alternative FIT cut-off levels.

Methods
The MISCAN cancer screening model was used to simulate 144 strategies varying screening intervals, age ranges and FIT cut-offs. Outputs estimated net costs, quality-adjusted life-years (QALYs) and number of colonoscopies required.

Results
A combination of reduction in FIT cut-off to 50ng Hb/ml, extending the screening interval to 3 years and reducing the start age to 55, saves 20% more QALYs, reduces costs by 7%, and yields a 17% reduction in colonoscopy requirements.

Conclusion
Simple changes to Bowel-Screen could save lives, reduce costs and relieve pressure on colonoscopy capacity. The extent of the potential improvements depends in part on the acceptability of lengthening the screening interval.

Period	07 Nov 2017
Event title	International Society For Pharmacoeconomics and Outcomes Research 20th Annual European Congress: The Evolution of Value in Health Care
Event type	Conference
Location	Glasgow, United KingdomShow on map
Degree of Recognition	International