The impact of CT colonography for colorectal cancer screening on the UK NHS
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Biennial faecal occult blood testing (FOBT) for individuals aged 60–69 years is the primary screening tool for colorectal cancer (CRC) in the UK NHS, despite a large number of patients undergoing an unnecessary optical colonoscopy (OC) and evidence from modelling studies to suggest that more cost-effective technologies exist. CT colonography (CTC) is an emerging CRC screening technology with the potential to prevent CRC by detecting pre-cancerous polyps and to detect cancer at an earlier stage.
To assess the impact of introducing CTC into the UK NHS screening programme for CRC on key health outcomes as well as the NHS budget and healthcare resource capacity.
A discrete Markov model was used to reflect the natural history of CRC and the impact of three screening scenarios (biennial FOBT with and without CTC triage of patients referred to OC, and CTC every 5 years) on a range of health outcomes, including the incidence and prevalence of CRC, in a hypothetical cohort of individuals. The yearly costs, health outcomes and healthcare resource capacity requirements were estimated over a 10-year period (2009–18).
Using CTC to follow up FOBT-positive patients (scenario 2) was less costly than directing all FOBT-positive patients to OC (scenario 1); saving d776 283 over 10 years for 100 000 individuals invited for screening (year 2007 values), primarily by avoiding approximately 1700 OCs, but was estimated to require 2200 additional CT scans. Implementing a programme of 5-yearly CTC as a primary screen is expected to be more expensive than FOBT screening over the short term (driven by high screening and diagnosis costs), despite substantial savings in treatment costs for CRC over the 10-year time horizon of the model and improved health outcomes.
Adding CTC into the existing NHS Bowel Cancer Screening Programme as part of a preventive screening strategy could be less costly to the NHS over the longer term when used to triage FOBT-positive patients to appropriate follow-up. Increased demand for radiology services may be compensated for by reduced demand in endoscopy units.
- 1.Office for National Statistics. Mortality statistics: cause. Review of the Registrar General on deaths by cause, sex and age, in England and Wales, 2005. Newport: Office for National Statistics, 2006 (Series DH2, No. 32) [online]. Available from URL: http://www.statistics.gov.uk/downloads/theme_health/Dh2_32/DH2_No32_2005.pdf [Accessed 2010 Dec 4]Google Scholar
- 2.Office for National Statistics. Cancer statistics registrations: registrations of cancer diagnosed in 2005, England, Newport: Office for National Statistics, 2008 (Series MB1, No. 36) [online]. Available from URL: http://www.statistics.gov.uk/downloads/theme_health/MB1_36/MB1_No36_2005.pdf [Accessed 2010 Dec 4]Google Scholar
- 6.National Institute for Health and Clinical Excellence. Improving outcomes in colorectal cancers: manual update. London: NICE, 2004 [online]. Available from URL: http://www.nice.org.uk/nicemedia/pdf/CSGCCfullguidance.pdf [Accessed 2010 Dec 4]Google Scholar
- 7.Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58(3): 130–60PubMedCrossRefGoogle Scholar
- 16.Tappenden P, Eggington S, Nixon R, et al. Colorectal cancer screening options appraisal: cost-effectiveness, cost-utility and resource impact of alternative screening options for colorectal cancer. Report to the English Bowel Cancer Screening Working Group. Sheffield: University of Sheffield, School of Health and Related Research (ScHARR), 2004 Sep [online]. Available from URL: http://www.cancerscreening.nhs.uk/bowel/scharr.pdf [Accessed 2010 Dec 4]Google Scholar
- 21.Marshall DA, Johnson FR, Kulin NA, et al. How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? A comparison in Canada and the United States using a stated-choice survey. Health Econ 2009 Dec; 18(12): 1420–39Google Scholar
- 23.National Institute for Health and Clinical Excellence. Developing costing tools: methods guide. London: NICE, 2008Google Scholar
- 24.NHS Cancer Screening Programmes. NHS bowel cancer screening programme [online]. Available from URL: http://www.cancerscreening.nhs.uk/bowel/index.html [Accessed 2010 Dec 4]
- 25.Weller D, Moss S, Butler P, et al. English pilot of bowel cancer screening: an evaluation of the second round. Final report to the Department of Health. Edinburgh: University of Edinburgh, 2006 Feb [online]. Available from URL: http://www.cancerscreening.nhs.uk/bowel/pilot-2nd-round-evaluation.pdf [Accessed 2010 Dec 4]Google Scholar
- 28.Brown S, Redgwell G, editors. Key population and vital statistics (series VS No. 33, PPI No. 29). Newport: Office for National Statistics, 2006 [online]. Available from URL: http://www.statistics.gov.uk/downloads/theme_population/KPVS33_2006/FINAL_KPVS2006-web.pdf [Accessed 2010 Dec 4]Google Scholar
- 30.UK Department of Health. NHS Payment by Results (PbR) in 2007–08 [online]. Available from URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_062914 [Accessed 2008 Feb 16]
- 31.UK Department of Health. NHS reference costs 2006–2007. London: Department of Health, 2008 [online] Available from URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082571 [Accessed 2010 Dec 4]Google Scholar
- 36.UK Department of Health. The NHS cancer plan: a plan for investment, a plan for reform (product no. 22293). London: Department of Health, 2000 Sep 27 [online]. Available from URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009609 [Accessed 2010 Dec 4]Google Scholar