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dc.contributor.authorLew J-Ben_US
dc.contributor.authorSt John DJBen_US
dc.contributor.authorMacrae FAen_US
dc.contributor.authorEmery JDen_US
dc.contributor.authorEe HCen_US
dc.contributor.authorJenkins MAen_US
dc.contributor.authorHe Een_US
dc.contributor.authorGrogan Pen_US
dc.contributor.authorCaruana Men_US
dc.contributor.authorGreuter MJEen_US
dc.contributor.authorCoupé VMHen_US
dc.contributor.authorCanfell Ken_US
dc.date.accessioned2019-03-28T01:25:15Z-
dc.date.available2019-03-28T01:25:15Z-
dc.date.issued2018-12-
dc.identifier.urihttp://researchpubs.cancercouncil.com.au/cancercounciljspui/handle/1/2050-
dc.description.abstractBackground: The Australian National Bowel Cancer Screening Program (NBCSP) is rolling out 2-yearly immunochemical fecal occult blood test screening in people aged 50 to 74 years. This study aimed to evaluate the benefits, harms, and cost-effectiveness of extending the NBCSP to younger and/or older ages. Methods: A comprehensive validated microsimulation model, Policy1-Bowel, was used to simulate the fully rolled-out NBCSP and alternative strategies assuming screening starts at 40 or 45 years and/or ceases at 79 or 84 years given three scenarios: (i) perfect adherence (100%), (ii) high adherence (60%), and (ii) low adherence (40%, as currently achieved). Results: The current NBCSP will reduce colorectal cancer incidence (mortality) by 23% to 51% (36% to 74%) compared with no screening (range reflects participation); extending screening to younger or older ages would result in additional reductions of 2 to 6 (2 to 9) or 1 to 3 (3 to 7) percentage points, respectively. With an indicative willingness-to-pay threshold of A$50,000/life-year saved (LYS), only screening from 50 to 74 years [incremental cost-effective ratio (ICER): A$2,984–5,981/LYS) or from 45 to 74 years (ICER: A$17,053–29,512/LYS) remained cost-effective in all participation scenarios. The number-needed-to-colonoscope to prevent a death over the lifetime of a cohort in the current NBCSP is 35 to 49. Starting screening at 45 years would increase colonoscopy demand for program-related colonoscopies by 3% to 14% and be associated with 55 to 170 additional colonoscopies per additional death prevented. Conclusions: Starting screening at 45 years could be cost-effective, but it would increase colonoscopy demand and would be associated with a less favorable incremental benefits-to-harms trade-off than screening from 50 to 74 years. Impact: The study underpins recently updated Australian colorectal cancer management guidelines that recommend that the NBCSP continues to offer bowel screening from 50 to 74 years.en_US
dc.subject.otherCancer Type - Bowel Colorectal Canceren_US
dc.titleBenefits, harms and costs of potential age-extensions to the National Bowel Cancer Screening Program in Australiaen_US
dc.typePeer Reviewed Journal Articleen_US
dc.identifier.journaltitleCancer Epidemiology, Biomarkers & Preventionen_US
dc.identifier.volume27en_US
dc.identifier.issue12en_US
dc.identifier.doi10.1158/1055-9965.EPI-18-0128-
dc.identifier.divisionCancer Research Divisionen_US
Appears in Collections:Research Articles

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