Table 47National estimates of ability of current volume or additional available capacity of flexible sigmoidoscopy or colonoscopy to meet projected demand for endoscopy, by different demand scenarios

Author, Year
Study Design
Setting
Data Collection or Data Inputs for Capacity/VolumeModel Description to Project DemandResultsQuality Rating
Demand scenario: all FOBT screening
Ladabaum et al., 2005201NoneCurrent and projected demand (in various screening scenarios) estimated by Markov modelAssuming 75% uptake, demand for colonoscopy would be 3.8 million if all screening by FOBTGood
Demand scenario: FS screening every 5 years
Ladabaum et al., 2005201NoneCurrent and projected demand (in various screening scenarios) estimated by Markov modelAssuming 75% uptake, demand for FS would be 10 million and demand for colonoscopy would be 2.7 million if all screening by FSGood
Brown et al., 2003195

Cross-sectional and modeling

National sample of MDs; US population
Current volume estimated by survey of national sample of primary care physicians, gastroenterologists, and general surgeonsDemand estimated by microsimulation model that incorporates population estimates, assumptions about test performance and screening program policyAssuming 70% adherence: screening of national population with FS every 5 years would require the delivery of “almost 10 million” FSs in 2000 (2 times current volume)Fair
Demand scenario: annual FOBT/FS every 5 years
Ladabaum et al., 2005 (2887)201NoneCurrent and projected demand (in various screening scenarios) estimated by Markov modelAssuming 75% adherence, demand for FS would be 6.9 million and demand for colonoscopy would be 4.7 million if all screening by FOBT/FSGood
Vijan et al., 2004200

Secondary data analysis and modeling

US population
Current volume of colonoscopies conducted by gastroenterologists estimated by analysis of CORI databaseDemand estimated by Markov model; number of lifetime colonoscopies and FSs per patient for the US population under various scenariosAssuming 70% adherence, an FOBT/FS screening strategy would require an incremental number of 1.2 million colonoscopies (above baseline of 1.69 million per year)

Assuming 100% adherence, an FOBT/FS screening strategy would require an incremental number of 2.39 million colonoscopies (above baseline of 1.69 million per year)
Fair (volume estimates)

Good (demand estimates)
Demand scenario: all colonoscopy screening
Ladabaum et al., 2005201NoneCurrent and projected demand (in various screening scenarios) estimated by Markov modelAssuming 75% uptake, demand for colonoscopy would be 8.1 million if all screening by colonoscopyGood
Vijan et al., 2004200

Secondary data analysis and modeling

US population
Current volume of colonoscopies conducted by gastroenterologists estimated by analysis of CORI databaseDemand estimated by Markov model; number of lifetime colonoscopies and FSs per patient for the US population under various scenariosAssuming 70% adherence, a colonoscopy screening strategy every 10 years would require an incremental number of 5.0 million colonoscopies (above baseline of 1.69 million per year)

Assuming 100% adherence, a colonoscopy screening strategy every 10 years would require an incremental number of 6.3 million colonoscopies (above baseline of 1.69 million per year)
Fair (volume estimates)

Good (demand estimates)
Brown et al., 2003195

Cross-sectional and modeling

National sample of MDs; US population
Current volume estimated by survey of national sample of primary care physicians, gastroenterologists, and general surgeonsDemand estimated by microsimulation model that incorporates population estimates, assumptions about test performance, and screening program policyAssuming 70% adherence, screening of national population with colonoscopy every 10 years would require 4.8 million screening/surveillance colonoscopies in 2000 (3 times the current volume of 1.6 million)Fair
Demand scenario: screening the unscreened by various strategies
Seeff et al., 2004202

Modeling

US population
Additional available capacity estimates from Seeff et al., 2004Current unscreened population at average risk estimated using census data, adjusted for estimates of persons at higher risk and using screening rates from NHIS41.8 million persons unscreened

Using 100% of additional available capacity, it would take 3 years at current screening patterns or 6 years using 100% FS or FOBT/FS to screen the unscreened population

Using 100% of additional available capacity, it would take 5 years to screen the unscreened population with colonoscopy

For a program using FOBTs, there would be enough capacity for the necessary follow-up colonoscopies within 1 year
Good
Demand scenario: Increasing demand for CT colonography
Ladabaum et al., 2005 (2887)201NoneCurrent and projected demand (in various screening scenarios) estimated by Markov modelAssuming 75% uptake, demand for colonoscopy would be 6.2 million CTC and 3.3 million colonoscopies if all screening by CTCGood
Hur et al., 2004199

Secondary data analysis and modeling

US population
Current colonoscopy volume estimated from CORI databaseDemand for colonoscopy predicted from mathematical modelCurrent volume: 6.47 million colonoscopies 1.98 million colonoscopies for screening (29%)

If CTC used as primary modality for CRC screening, assuming 55% adherence to screening and 67% of screening is CTC, in the initial 5-year period after implementation of CTC, demand for colonoscopy could decrease by 1.78 million; partially offset by 0.34 million follow-up colonoscopies for CTC with positive findings (10 mm polyp)
Fair
Pickardt et al., 2008203

Modeling

US population
Current volume of CTC estimated from secondary data on CT scanners in the USMarkov model used to estimate demand for the US populationAssuming 60% compliance with screening, 67% of screening is CTC, and rise in number and percentage of CT scanners performing CTC (from n = 718/10% to n = 10,000/90%), there is sufficient capacity to screen 10 years from now in a steady-state scenarioFair

CORI, Clinical Outcomes Research Initiative; CRC, colorectal cancer; CT, computed tomography; CTC, computed tomography colonography; FOBT, fecal occult blood test; FS, flexible sigmoidoscopy; MDs, physicians; NHIS, National Health Interview Survey.

From: 4, Results

Cover of Enhancing the Use and Quality of Colorectal Cancer Screening
Enhancing the Use and Quality of Colorectal Cancer Screening.
Evidence Reports/Technology Assessments, No. 190.
Holden DJ, Harris R, Porterfield DS, et al.

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