How Ireland’s Colorectal Screening Programme Could SAVE MORE LIVES, SAVE MONEY & Stay Within Existing Colonoscopy Capacity Limits: Evidence From The MISCAN Microsimulation Model

McFerran, E. (Advisor), James F. O'Mahony (Contributor), McVicar, D. (Advisor), Ann Zauber (Advisor), Kee, F. (Advisor), Iris Lansdorp_Vogelaar (Advisor)

Activity: Talk or presentation typesInvited talk


Overview of the research provided to the statutory service provider.

OBJECTIVES: Ireland’s colorectal cancer screening programme, BowelScreen, offers biennial faecal immunochemical testing (FIT) for 60-69 year-olds. Screening sensitivity and specificity of FIT are adjusted by varying the test positivity threshold. BowelScreen uses a FIT cut-off of 225ng/ml of haemoglobin. Existing literature indicates that a lower cut-off of 50ng/ml would cost less and be more effective, but require more colonoscopies for positive screen findings, which is a key capacity constraint. The objective of this study was to determine if a more effective, less costly screening strategy exists within BowelScreen’s current colonoscopy capacity requirements.
METHODS: The MISCAN cancer screening model was used to simulate 144 strategies of varying screening intervals, age ranges and FIT cut-offs. Outputs estimated were net costs, quality-adjusted life-years (QALYs) and number of colonoscopies required. RESULTS: A combination of a reduction in the FIT cut-off to 50ng/ml, an extended screening interval of 4 years and a screening start age of 60 saves 13% more lives, reduces costs by 9%, and yields a 2% reduction in colonoscopy requirements.
CONCLUSIONS: Simple changes to BowelScreen could save lives, reduce costs and relieve pressure on colonoscopy capacity.
Period16 Nov 2018
Held atNational Screening Service, Ireland
Degree of RecognitionInternational


  • Cancer screening
  • Cancer Prevention
  • Microsimulation Modeling
  • health economics