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Title: Long-Term Impact of the Dutch Colorectal Cancer Screening Programme on Cancer Incidence: Exploration of the Serrated Pathway
Authors: Greuter MJ; Lew JB; Berkhof J; Canfell K; Dekker E; Meijer GA; Coupe VM
Categories: Cancer Type - Bowel Colorectal Cancer
Early Detection, Diagnosis, and Prognosis - Resources and Infrastructure
Year: 2014
Journal Title: Value in Health
Volume: 17
Issue: 7
Page number start: A323
Page number end: A686
Abstract: Objectives The Netherlands has recently started with the stepwise implementation of biennial faecal immunochemical testing for colorectal cancer (CRC). We evaluated the impact of the transition to, and the fully implemented screening programme on the long-term CRC incidence and colonoscopy demand. Methods The previously reported and calibrated ASCCA model was set up to simulate the Dutch CRC screening programme between 2014 and 2044. We adopted an open-model approach by simulating multiple birth cohorts and combining the results while accounting for the ageing of the population. Besides a no screening scenario, we evaluated the impact of screening under three sets of natural history assumptions which differed in the contribution of the serrated pathway to the CRC incidence (0%, 15% and 30%). Model-predicted outcomes were CRC incidence and colonoscopy demand per year. Results Due to ageing, the model-predicted CRC incidence in the no screening scenario increased from 77/100,000 in 2014 to 109/100,000 in 2044. Under screening, the predicted CRC incidence in 2014 was between 105/100,000 (assuming all CRCs originate from adenomas) and 109/100,000 (assuming that 30% of CRCs arises from serrated lesions) due to the detection of asymptomatic, prevalent tumours. After this peak, the predicted incidence gradually decreased until in 2039 a new equilibrium was reached, ranging between 65/100,000 and 71/100,000 assuming that 100% versus 70% of CRCs originate from adenomas, respectively. Due to the stepwise implementation, the predicted number of colonoscopies required for the screening programme increased gradually over time from 38,000 (752,199 invitees) in 2014 to 117,000 (2,154,875 invitees) in 2044. Conclusions The Dutch screening programme will markedly decrease CRC incidence in the next 25 years. The conclusions about the impact of screening were robust to key natural history assumptions. With the results of this study, decision-makers can anticipate the expected change in CRC-related health care use and colonoscopy demand.
Division: Cancer Research Division
Appears in Collections:Research Articles

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