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

被引：2
作者：
Lew, Jie-Bin [1 ,2 ]
St John, D. James B. [3 ,4 ]
Macrae, Finlay A. [4 ,5 ,6 ]
Emery, Jon D. [7 ,8 ,9 ,10 ]
Ee, Hooi C. [11 ]
Jenkins, Mark A. [12 ]
He, Emily [1 ,2 ]
Grogan, Paul [13 ]
Caruana, Michael [1 ,2 ]
Greuter, Marjolein J. E. [14 ]
Coupe, Veerle M. H. [14 ]
Canfell, Karen [1 ,2 ,15 ]
机构：
[1] Canc Council New South Wales, Canc Res Div, Sydney, NSW, Australia
[2] UNSW, Prince Wales Clin Sch, Sydney, NSW, Australia
[3] Canc Council Victoria, Prevent Div, Victoria, Melbourne, Australia
[4] Univ Melbourne, Royal Melbourne Hosp, Dept Med, Victoria, Australia
[5] Royal Melbourne Hosp, Dept Colorectal Med & Genet, Victoria, Australia
[6] Royal Melbourne Hosp, Dept Colorectal Med & Genet, Dept Med, Victoria, Australia
[7] Univ Melbourne, Victoria, Australia
[8] Univ Melbourne, Dept Gen Practice, Melbourne, Vic, Australia
[9] Univ Melbourne, Ctr Canc Res, Victorian Comprehens Canc Ctr, Melbourne, Vic, Australia
[10] Univ Cambridge, Dept Publ Hlth & Primary Care, Primary Care Unit, Cambridge, England
[11] Sir Charles Gairdner Hosp, Dept Gastro enterol, Western Australia, Australia
[12] Univ Melbourne, Melbourne Sch Populat & Global Hlth, Ctr Epidemiol & Biostatist, Victoria, Australia
[13] Canc Council Australia, Sydney, NSW, Australia
[14] Vrije Univ Amsterdam, Dept Epidemiol & Biostatist, Med Ctr, Amsterdam, Netherlands
[15] Univ Sydney, Sch Publ Hlth, Sydney Med Sch, Sydney, NSW, Australia
来源：
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION | 2018年 / 27卷 / 12期
基金：
英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词：
COLORECTAL-CANCER; SURVIVAL; COLONOSCOPY;
D O I：
10.1158/1055-9965.EPI-18-0128
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
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, Policy)-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$2,9845,981/INS) 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 costeffective, but it would increase colonoscopy demand and would he 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. (C) 2018 AACR.
引用
收藏
页码：1450 / 1461
页数：12
相关论文
共 36 条
[1]  
AIHW. Australian Institute of Health and Welfare (AIHW) 2014, 2014, AUSTR CANC INC MORT
[2]   The rapidly escalating cost of treating colorectal cancer in Australia [J].
Ananda, Sumitra ;
Kosmider, Suzanne ;
Tran, Ben ;
Field, Kathryn ;
Jones, Ian ;
Skinner, Iain ;
Guerrieri, Mario ;
Chapman, Michael ;
Gibbs, Peter .
ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, 2016, 12 (01) :33-40
[3]  
Australian Bureau of Statistics, 2015, CONS PRIC IND MARCH
[4]  
Australian Bureau of Statistics, 2013, CONS PRIC IND MARCH
[5]  
Australian Government Department of Health, 2013, MED BEN SCHED BOOK O
[6]  
Australian Government Department of Health, 2016, PHARM BEN ADV COMM P
[7]  
Australian Institute of Health and Welfare, 2017, AUSTR CANC INC MORT
[8]  
Australian Institute of Health and Welfare, 2015, CANC SER, V94
[9]  
Australian Institute of Health and Welfare (AIHW), 2015, GRIM GEN REC INC MOR
[10]  
Australian Institute of Health and Welfare (AIHW), 2018, NAT BOW CANC SCREEN
1234