The value of models in informing resource allocation in colorectal cancer screening: the case of the Netherlands

Hees, Frank van; Zauber, Ann G.; Veldhuizen, Harriët van; Heijnen, Marie-Louise A.; Penning, Corine; Koning, Harry J. de; Ballegooijen, Marjolein van; Lansdorp–Vogelaar, Iris

doi:10.1136/gutjnl-2015-309316

Cited by 61 publications

(69 citation statements)

References 46 publications

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“…foregoing screening in the oldest age groups, postponing screening in other age groups or increasing the cut-off, the latter resulted in the largest reduction in colonoscopies for every death that could no longer be prevented and thus was most efficient [10]. These examples illustrate the important role modeling can play in both evaluating and improving existing CRC screening programs.…”

Section: A N U S C R I P Tmentioning

confidence: 86%

“…This is because over time, the information from regular monitoring is available to estimate pre-and post-screening CRC incidence and mortality. However, modeling retains its value [10] because in every program, even those that are fully implemented, there is always room for improvement. For example, there may be regional variation in performance indicators (e.g., participation, follow-up colonoscopy compliance) and modeling can be used to estimate the impact of this regional variation on longterm outcomes of the screening program.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 95%

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Assessment of a cancer screening program

Rabeneck

Lansdorp–Vogelaar

2015

Best Practice & Research Clinical Gastroenterology

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Section: A N U S C R I P Tmentioning

confidence: 86%

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 95%

Assessment of a cancer screening program

Rabeneck

Lansdorp–Vogelaar

2015

Best Practice & Research Clinical Gastroenterology

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“…4 The model has been used to inform the US Preventive Services Task Force recommendations for colorectal cancer screening, as well as national screening programs. 10,11 …”

Section: Methodsmentioning

confidence: 99%

Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer

Meester

M.D.

Zauber

et al. 2017

Intl Journal of Cancer

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Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related with patients’ post-colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT) versus primary colonoscopy screening for colorectal cancer. Using an established microsimulation model, we predicted the lifetime colorectal cancer incidence and mortality benefits of annual FIT versus ten-yearly colonoscopy screening at differing ADR levels (quintiles; averages 15.3–38.7%), with colonoscopy performance assumptions estimated from community-based data on physician ADRs and patients’ post-colonoscopy risk of cancer. For patients receiving FIT screening with follow-up colonoscopy by physicians from the highest ADR quintile, simulated lifetime cancer incidence and mortality were 28.8 and 5.4 per 1000, respectively, versus 20.6 and 4.4 for primary colonoscopy screening (risk ratios, RR=1.40; 95% probability interval (PI), 1.19–1.71 for incidence, and RR=1.22; 95%PI, 1.02–1.54 for mortality). With every 5% point ADR decrease, lifetime cancer incidence was predicted to increase on average 9.0% for FIT versus 12.3% for colonoscopy, and mortality increased 9.9% versus 13.3%. In ADR quintile 1, simulated mortality was lower for FIT than colonoscopy screening (10.1 versus 11.8; RR=0.85; 95%PI, 0.83–0.90), while incidences were more similar. This suggests that relative cancer incidence and mortality reductions for FIT versus colonoscopy screening may differ by ADR, with fewer predicted deaths with colonoscopy screening in higher ADR settings and fewer deaths with annual FIT screening in lower ADR settings.

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“…Hence, assessing the demand for treatment and planning for sufficient manpower are essential to successfully implementing screening. In screening programs where capacity (eg, for follow‐up) has been limited, program implementation has been done gradually to take this into account . Therefore, the aim of the current study was to project the treatment capacity required for the full‐scale implementation of LDCT screening for lung cancer in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…In screening programs where capacity (eg, for follow-up) has been limited, program implementation has been done gradually to take this into account. 9 Therefore, the aim of the current study was to project the treatment capacity required for the full-scale Cancer June 15, 2019 implementation of LDCT screening for lung cancer in the United States.…”

Section: Introductionmentioning

confidence: 99%

Treatment capacity required for full‐scale implementation of lung cancer screening in the United States

Blom

Haaf

Arenberg

et al. 2019

Cancer

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Background Full‐scale implementation of lung cancer screening in the United States will increase detection of early stages. This study was aimed at assessing the capacity required for treating those cancers. Methods A well‐established microsimulation model was extended with treatment data from the National Cancer Database. We assessed how treatment demand would change when implementing lung cancer screening in 2018. Three policies were assessed: 1) annual screening of current smokers and former smokers who quit fewer than 15 years ago, aged 55 to 80 years, with a smoking history of at least 30 pack‐years (US Preventive Services Task Force [USPSTF] recommendations); 2) annual screening of current smokers and former smokers who quit fewer than 15 years ago, aged 55 to 77 years, with a smoking history of at least 30 pack‐years (Centers for Medicare and Medicaid Services [CMS] recommendations); and 3) annual screening of current smokers and former smokers who quit fewer than 10 years ago, aged 55 to 75 years, with a smoking history of at least 40 pack‐years (the most cost‐effective policy in Ontario [Ontario]). The base‐case screening adherence was a constant 50%. Sensitivity analyses assessed other adherence levels, including a linear buildup to 50% between 2018 and 2027. Results The USPSTF policy would require 37.0% more lung cancer surgeries in 2015‐2040 than no screening, 2.2% less radiotherapy, and 5.4% less chemotherapy; 5.7% more patients would require any therapy. The increase in surgical demand would be 96.1% in 2018, 46.0% in 2023, 38.3% in 2028, and 24.9% in 2040. Adherence strongly influenced results. By 2018, surgical demand would range from 52,619 (20% adherence) to 96,121 (80%). With a gradual buildup of adherence, the increase in surgical demand would be 9.6% in 2018, 38.3% in 2023, 42.0% in 2028, and 24.4% in 2040. Results for the CMS and Ontario policies were similar, although the changes in comparison with no screening were smaller. Conclusions Full‐scale implementation of lung cancer screening causes a major increase in surgical demand, with a peak within the first 5 years. A gradual buildup of adherence can spread this peak over time. Careful surgical capacity planning is essential for successfully implementing screening.

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The value of models in informing resource allocation in colorectal cancer screening: the case of the Netherlands

Cited by 61 publications

References 46 publications

Assessment of a cancer screening program

Assessment of a cancer screening program

Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer

Treatment capacity required for full‐scale implementation of lung cancer screening in the United States

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