Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland

Hdl Handle:
http://hdl.handle.net/10147/288503
Title:
Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland
Authors:
Sharp, Linda; Tilson, Lesley; Whyte, Sophie; Ceilleachair, Alan O; Walsh, Cathal; Usher, Cara; Tappenden, Paul; Chilcott, James; Staines, Anthony; Barry, Michael; Comber, Harry
Citation:
BMC Health Services Research. 2013 Mar 19;13(1):105
Issue Date:
19-Mar-2013
URI:
http://dx.doi.org/10.1186/1472-6963-13-105; http://hdl.handle.net/10147/288503
Abstract:
Abstract Background Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning.
Item Type:
Journal Article

Full metadata record

DC FieldValue Language
dc.contributor.authorSharp, Linda-
dc.contributor.authorTilson, Lesley-
dc.contributor.authorWhyte, Sophie-
dc.contributor.authorCeilleachair, Alan O-
dc.contributor.authorWalsh, Cathal-
dc.contributor.authorUsher, Cara-
dc.contributor.authorTappenden, Paul-
dc.contributor.authorChilcott, James-
dc.contributor.authorStaines, Anthony-
dc.contributor.authorBarry, Michael-
dc.contributor.authorComber, Harry-
dc.date.accessioned2013-05-05T16:14:33Z-
dc.date.available2013-05-05T16:14:33Z-
dc.date.issued2013-03-19-
dc.identifier.citationBMC Health Services Research. 2013 Mar 19;13(1):105-
dc.identifier.urihttp://dx.doi.org/10.1186/1472-6963-13-105-
dc.identifier.urihttp://hdl.handle.net/10147/288503-
dc.description.abstractAbstract Background Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning.-
dc.titleUsing resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland-
dc.typeJournal Article-
dc.language.rfc3066en-
dc.rights.holderLinda Sharp et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2013-04-26T15:07:07Z-
All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.