Modeling costs and benefits of the organized colorectal cancer screening programme and its potential future improvements in Hungary

Csanádi, Marcell; Gini, Andrea; Koning, Harry J. de; Széles, György; Pitter, J; Oroszi, Beatrix; Pataki, Piroska; Fadgyas-Freyler, Petra; Korponai, Gyula; Vokó, Zoltán; Lansdorp–Vogelaar, Iris

doi:10.1177/0969141320968598

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…15 Population-level breast cancer screening has been available for women aged 45-64 since 2002, 16 while colorectal cancer screening was initiated for people aged 50-70 in 2018. 17 The Hungarian healthcare system is highly centralised. The state has exclusive powers to set the strategic direction, control funding, define the benefits package and issue and implement regulations.…”

Section: Open Accessmentioning

confidence: 99%

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Heterogeneous impact of the COVID-19 pandemic on lung, colorectal and breast cancer incidence in Hungary: results from time series and panel data models

Elek

Csanádi²,

Fadgyas-Freyler

et al. 2022

BMJ Open

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ObjectiveDuring the COVID-19 pandemic, health system resources were reallocated to provide care for patients with COVID-19, limiting access for others. Patients themselves also constrained their visits to healthcare providers. In this study, we analysed the heterogeneous effects of the pandemic on the new diagnoses of lung, colorectal and breast cancer in Hungary.DesignTime series and panel models of quarterly administrative data, disaggregated by gender, age group and district of residence.ParticipantsData for the whole population of Hungary between the first quarter of 2017 and the second quarter of 2021.Main outcome measuresNumber of patients newly diagnosed with lung, colorectal and breast cancer, defined as those who were hospitalised with the appropriate primary International Classification of Diseases Tenth Revision diagnosis code but had not had hospital encounters with such a code within the previous 5 years.ResultsThe incidence of lung, colorectal and breast cancer decreased by 14.4% (95% CI 10.8% to 17.8%), 19.9% (95% CI 12.2% to 26.9%) and 15.5% (95% CI 2.5% to 27.0%), respectively, during the examined period of the pandemic, with different time patterns across cancer types. The incidence decreased more among people at least 65 years old than among the younger (p<0.05 for lung cancer and p<0.1 for colorectal cancer). At the district level, both the previously negative income gap in lung cancer incidence and the previously positive income gap in breast cancer incidence significantly narrowed during the pandemic (p<0.05).ConclusionsThe decline in new cancer diagnoses, caused by a combination of supply-side and demand-side factors, suggests that some cancer cases have remained hidden. It calls for action by policy makers to engage individuals with high risk of cancer more in accessing healthcare services, to diagnose the disease early and to prepare for effective management of patient pathways from diagnosis to survival or end-of-life care.

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Section: Open Accessmentioning

confidence: 99%

“…The three most common types are lung, colorectal and breast cancer 15. Population-level breast cancer screening has been available for women aged 45–64 since 2002,16 while colorectal cancer screening was initiated for people aged 50–70 in 2018 17…”

Section: Introductionmentioning

confidence: 99%

Heterogeneous impact of the COVID-19 pandemic on lung, colorectal and breast cancer incidence in Hungary: results from time series and panel data models

Elek

Csanádi²,

Fadgyas-Freyler

et al. 2022

BMJ Open

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“…Nine simulation models were identified, including three Cancer Intervention and Surveillance Modeling Network (CISNET) CRC models (CRC Simulated Population Model for Incidence and Natural History (CRC-SPIN) [ 14 , 24 , 30 , 31 , 42 ], Simulation Model of Colorectal Cancer (SimCRC) [ 14 , 24 , 30 , 31 , 36 , 42 ] and MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon) [ 14 , 20 , 21 , 22 , 24 , 25 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 42 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]), adenoma and serrated pathway to colorectal cancer (ASCCA) [ 12 , 19 , 26 , 27 , 28 , 43 ], Microsimulation-based colon modelling open-source tool (CMOST) [ 23 , 41 ], Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) [ 40 , 44 , 68 , 69 ...…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis

Zheng

Schrijvers

Greuter

et al. 2023

Cancers

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(1) Background: The aim of this study was to pool and compare all-cause and colorectal cancer (CRC) specific mortality reduction of CRC screening in randomized control trials (RCTs) and simulation models, and to determine factors that influence screening effectiveness. (2) Methods: PubMed, Embase, Web of Science and Cochrane library were searched for eligible studies. Multi-use simulation models or RCTs that compared the mortality of CRC screening with no screening in general population were included. CRC-specific and all-cause mortality rate ratios and 95% confidence intervals were calculated by a bivariate random model. (3) Results: 10 RCTs and 47 model studies were retrieved. The pooled CRC-specific mortality rate ratios in RCTs were 0.88 (0.80, 0.96) and 0.76 (0.68, 0.84) for guaiac-based fecal occult blood tests (gFOBT) and single flexible sigmoidoscopy (FS) screening, respectively. For the model studies, the rate ratios were 0.45 (0.39, 0.51) for biennial fecal immunochemical tests (FIT), 0.31 (0.28, 0.34) for biennial gFOBT, 0.61 (0.53, 0.72) for single FS, 0.27 (0.21, 0.35) for 10-yearly colonoscopy, and 0.35 (0.29, 0.42) for 5-yearly FS. The CRC-specific mortality reduction of gFOBT increased with higher adherence in both studies (RCT: 0.78 (0.68, 0.89) vs. 0.92 (0.87, 0.98), model: 0.30 (0.28, 0.33) vs. 0.92 (0.51, 1.63)). Model studies showed a 0.62–1.1% all-cause mortality reduction with single FS screening. (4) Conclusions: Based on RCTs and model studies, biennial FIT/gFOBT, single and 5-yearly FS, and 10-yearly colonoscopy screening significantly reduces CRC-specific mortality. The model estimates are much higher than in RCTs, because the simulated biennial gFOBT assumes higher adherence. The effectiveness of screening increases at younger screening initiation ages and higher adherences.

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“…Previous publications have shown similar examples for colorectal screening and cervical screening, highlighting that it is worth spending effort to remove barriers that affect the interval at which women participate in screening. 37,38 There are three noteworthy limitations of our analysis. First, it is based on the barrier assessment of one group of key informants.…”

Section: Discussionmentioning

confidence: 98%

Overcoming barriers: Modelling the effect of potential future changes of organized breast cancer screening in Italy

et al. 2023

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Objectives Organized breast cancer screening may not achieve its full potential due to organizational and cultural barriers. In Italy, two identified barriers were low attendance in Southern Italy and, in Italy as a whole, underscreening and overscreening in parts of the eligible population. The objective of this study was to identify potential changes to overcome these barriers and to quantify their costs and effects. Methods To assess the impact of potential measures to improve breast cancer screening in Italy, we performed an evaluation of costs and effects for increasing adherence for Southern Italy and harmonizing screening intervals (biennial screening) for the whole of Italy, using an online tool (EU-TOPIA evaluation tool) based on the MIcrosimulation SCreening ANalysis (MISCAN) model. Results Increasing adherence in Southern Italy through investing in mobile screening units has an acceptable cost-effectiveness ratio of €9531 per quality-adjusted life year gained. Harmonizing the screening interval by investing in measures to reduce opportunistic screening and simultaneously investing in mobile screening units to reduce underscreening is predicted to gain 1% fewer life-years, while saving 19% of total screening costs compared to the current situation. Conclusions Increasing adherence in Southern Italy and harmonizing the screening interval could result in substantial improvements at acceptable costs, or in the same benefits at lower costs. This example illustrates a systematic approach that can be easily applied to other European countries, as the online tools can be used by stakeholders to quantify effects and costs of a broad range of specific barriers, and ways to overcome them.

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Modeling costs and benefits of the organized colorectal cancer screening programme and its potential future improvements in Hungary

Cited by 11 publications

References 24 publications

Heterogeneous impact of the COVID-19 pandemic on lung, colorectal and breast cancer incidence in Hungary: results from time series and panel data models

Heterogeneous impact of the COVID-19 pandemic on lung, colorectal and breast cancer incidence in Hungary: results from time series and panel data models

Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis

Overcoming barriers: Modelling the effect of potential future changes of organized breast cancer screening in Italy

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