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 3 years and a reduced screening start age of 55 saves 20% more QALYs, reduces costs by 7%, and yields a 17% reduction in colonoscopy requirements. CONCLUSIONS: Simple changes to BowelScreen could save lives, reduce costs and relieve pressure on colonoscopy capacity.
|Publication status||Published - 20 May 2017|
|Event||International Society for Pharmacoeconomics and Outcomes Research: ISPOR 22nd Annual International Meeting - Sheraton Boston Hotel and the John B. Hynes Veterans Memorial Convention Center, Boston, United States|
Duration: 20 May 2017 → 24 May 2017
|Conference||International Society for Pharmacoeconomics and Outcomes Research|
|Period||20/05/2017 → 24/05/2017|
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McFerran, Ethna (Recipient), 2014
Prize: Fellowship awarded competitively