Evaluating options for a colorectal cancer screening programme in Ireland

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Evaluating options for a colorectal cancer screening programme in Ireland

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Effects may be in life-years gained (LYG) or quality-adjusted life ... also health outcomes over a ten year time horizon after the introduction of screening. ... – PowerPoint PPT presentation

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Title: Evaluating options for a colorectal cancer screening programme in Ireland


1
Evaluating options for a colorectal cancer
screening programme in Ireland
  • Sharp L, Tilson L, Whyte S, Ó Céilleachair A,
    Walsh C, Usher C, Tappenden P, Chilcott J,
    Staines A, Barry M Comber H.

Population-based cancer research in Ireland,
Davenport Hotel September 4th 2009
2
Background
  • Over 2,000 new cases of colorectal cancer (CRC)
    are diagnosed in the Republic of Ireland each
    year.
  • 2nd most common cancer for both genders
  • Over 900 deaths per annum from CRC
  • On most key indicators Irish people fare worse
    than their European contemporaries
  • Higher incidence rates
  • Lower survival rates
  • Higher mortality amongst men
  • As population ages incidence is projected to
    increase

3
Opportunity for Screening
  • If caught early, CRC is very treatable
  • Survival much higher in Stage I-II disease
  • Screening in place for many European countries
  • Numerous modalities exist for early detection of
    CRC
  • Guaic-based occult blood tests (gFOBT)
  • Immunochemical-based stool tests (FIT)
  • Flexible sigmoidoscopy

4
Cost-effectiveness analysis
  • Comparing the cost-effectiveness of two policies,
    A and B
  • ICER cost A cost B/effect A effect B
  • Effects may be in life-years gained (LYG) or
    quality-adjusted life years gained (QALYs)
  • The lower the ICER the more cost-effective A
    compared to B
  • 45,000 per QALY is an informal threshold of
    cost-effectiveness in an Irish setting

5
Evaluating Screening Options
  • Health technology assessment commissioned by HIQA
  • Evaluate using cost-effectiveness analysis
    competing alternative strategies for CRC
    screening in Ireland
  • Versus No Screening and also incrementally
    against each other
  • Estimate the likely resource burden of screening
    for a range of key services and also health
    outcomes over a ten year time horizon after the
    introduction of screening.

6
Methods
  • Core screening scenarios agreed with HIQA Expert
    Advisory Group
  • biennial FIT at ages 55-74
  • biennial gFOBT at ages 55-74, with reflex FIT
  • FSIG once only at age 60
  • Supplementary scenarios also considered
  • Diagnostic investigations for postive screen
    test colonoscopy or CT colonography
  • Surveillance for those with adenoma(s) 1cm
    removed following current consensus
    recommendations (Atkins Saunders, 2002)

7
Model
  • Markov model adapted from an existing model
    developed by collaborators in ScHARR
  • Natural history model of CRC
  • Hypothetical cohort of 55 year-olds tracked over
    their lifetime used for cost-effectiveness
  • Screening scenarios were then superimposed on
    this model
  • Outcome measures Cost per QALY and cost per Life
    Year Gained (LYG)
  • Alternatives compared to No Screening and each
    other
  • Costs and outcomes discounted _at_ 4
  • Healthcare payer perspective

8
Data
  • Model parameters
  • Natural history data
  • Data on the performance of tests
  • Cost data
  • Other data such as uptake
  • Data sourced from extensive literature reviews,
    information from existing screening programmes
    and expert opinion
  • Sensitivity analysis
  • One/multi way
  • Probabilistic sensitivity analysis

9
Performance and Uptake
10
Costs
11
Incremental Cost Effectiveness vs. No Screening
Costs and outcomes discounted at 4 1 Each
incremental value compares value for that
strategy to common baseline of no screening 2
gFOBT considered dominated by a combination of
FIT and FSIG
12
Cost-Effectiveness Plane
13
CE Plane Extended Dominance
14
Health Outcomes
15
Health Outcomes
  • Higher proportion of screen-detected with FIT
    (30 of all cancers, vs 14 with gFOBT and 3
    with FSIG)
  • Under all scenarios, screen-detected cancers have
    more favourable stage distribution than those
    detected symptomatically/clinically
  • Sensitivity analysis found analysis to be robust.
    Findings did not change when using LYG as outcome
    measure

16
FSIG v FIT
17
But
FITfaecal immunochemical test FSIG flexible
sigmoidoscopy gFOBTguaiac-based faecal occult
blood test 1 Over the entire lifetime of the
cohort, therefore for gFOBT and FIT includes 10
screening rounds 2 Related to screening,
diagnosis or surveillance 3 Complications
associated with diagnostic and surveillance
colonoscopy and, where relevant, FSIG 4 Major
abdominal bleeding, requiring admission or
intervention
18
Conclusions
  • Compared to No Screening all of the options
    considered could be termed highly cost-effective.
  • Biennial FIT 55-74 optimal strategy as it
    provides greater health gains at an acceptable
    ICER
  • Not insignificant resource considerations and
    complications need to be borne in mind

19
Thank You
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