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Cancer Epidemiol Biomarkers Prev. 2018 Dec;27(12):1450-1461. doi: 10.1158/1055-9965.EPI-18-0128. Epub 2018 Sep 6.

Benefits, Harms, and Cost-Effectiveness of Potential Age Extensions to the National Bowel Cancer Screening Program in Australia.

Author information

1
Cancer Research Division, Cancer Council New South Wales, Sydney, Australia. jiebin.lew@nswcc.org.au.
2
Prince of Wales Clinical School, UNSW, Sydney, Australia.
3
Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
4
Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
5
Department of Colorectal Medicine and Genetics, and Department of Medicine, The Royal Melbourne Hospital and University of Melbourne, Victoria, Australia.
6
Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
7
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kindgom.
8
Department of Gastroenterology, Sir Charles Gairdner Hospital, Western Australia, Australia.
9
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
10
Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
11
Cancer Council Australia, Sydney, New South Wales, Australia.
12
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
13
The University of Sydney, School of Public Health, Sydney Medical School, New South Wales, Australia.

Abstract

BACKGROUND:

The Australian National Bowel Cancer Screening Program (NBCSP) is rolling out 2-yearly immunochemical fecal occult blood test screening in people aged 50 to 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 40 or 45 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% to 51% (36% to 74%) compared with no screening (range reflects participation); extending screening to younger or older ages would result in additional reductions of 2 to 6 (2 to 9) or 1 to 3 (3 to 7) percentage points, respectively. With an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS), only screening from 50 to 74 years [incremental cost-effective ratio (ICER): A$2,984-5,981/LYS) or from 45 to 74 years (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 to 49. Starting screening at 45 years would increase colonoscopy demand for program-related colonoscopies by 3% to 14% and be associated with 55 to 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 favorable incremental benefits-to-harms trade-off than screening from 50 to 74 years.

IMPACT:

The study underpins recently updated Australian colorectal cancer management guidelines that recommend that the NBCSP continues to offer bowel screening from 50 to 74 years.

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