Colorectal Cancer Screening - Economic Considerations Terri
Green University of Canterbury Presentation for Future of Cancer
Screening in New Zealand. Auckland, 7 August 2015 Slide 2 Economic
considerations Is it value for money? (Yes, potentially) What are
the benefits? What are the costs? Can we achieve the benefits? Can
we afford it? Are there alternatives? 2 Slide 3 3 Slide 4 Fig 3.
Biennial FOBTi screening, 50-74 years: Referral and Surveillance
colonoscopy 2011-2031 (Participation 60%, Positivity 6.4%, 4.8%)
Green, Richardson and Parry (NZMJ, 2012) 4 Slide 5 Can we do it?
18000 colonoscopies rising to 28000 Assumes Participation 60%
Compared to 55% for pilot Positivity 6.4% for initial screen 4.8%
for later screens Compared to 7.5% for pilot 5 Slide 6 What is the
cost of Programme? - estimated at $39 M per year* (Sapere, 2015)
(Steady state cost; initial years more costly) Key Determinants of
cost: Participation rate in screening (pilot, 55%) Positivity rate
(pilot, 7.5%) How programme is delivered: Use of private sector for
colonoscopies Regional variations (*Range $26M-$50M, Sapere report
MOH 2015) 6 Slide 7 Can we afford it? Depends on other demands on
public money (Annual CRC treatment costs approx $83M*.) If it can
be delivered it is worthy of consideration Are there alternatives
to address Bowel cancer? E.G. screening by once only Flexible
Sigmoidoscopy. (*Sheerin, Green, Sarfati, Cox, NZMJ 2015) 7 Slide 8
Approx Comparison: Annual volumes FOBTi and Flexible Sigmoidoscopy
(60% participation) FOBTi (50-74, every 2 years) 618,000 target
371,000 screens 18,000 colonoscopies Flex sig (one-off, age 55)
60,000 target 36,000 screens 1800* colonoscopies (* 5%, Atkins,
Lancet, 2010) 8 Slide 9 Balancing costs and benefits: - FOBTi,
compared to Flex sig Greater Reduction in CRC incidence Greater
Reduction in mortality Higher cost Lower cost per QALY More adverse
events Higher colonoscopy load 9
