Report in English with a Dutch summary (KCE reports 45A)

KCE reports vol.45 Screening for Colorectal Cancer: Appendices 143
8 IMPLEMENTATION SCENARIOS AND
BUDGET IMPACT
8.1 SCENARIOS
To estimate the budget impact of mass screening for colorectal cancer we
analysed two general implementation scenarios. It should be emphasised that
the goal of these analyses is limited to budget impact estimation and that they
should not be considered as a cost-effectiveness analysis of screening tests.
These cost-effectiveness analyses are described in chapter 6.
In a first scenario an individual from the target group receives an invitation by
mail to participate in the screening program and to visit his GP for delivery of
the test kit. During a first visit the GP identifies the pre-screening risk of the
individual. Individuals who are at high risk for colorectal cancer should be
followed up for this risk (surveillance) and are therefore excluded from the
mass screening program. For average risk individuals, the GP provides extensive
information about the aims, consequences and drawbacks of CRC screening,
and if they agree to participate they are given the FOBT test kit. After
completion of the test the participant receives his result through the GP. If the
test is positive the participant is advised to undergo colonoscopy and referred
for the procedure. This scenario is further called the GP system .
In a second scenario, an individual from the target group is again invited by mail
to participate in the screening program, but in this scenario the letter contains
the test kit, together with detailed information about the nature of the
program, consequences, exclusion criteria, and instructions for use of the test
kit. The test is performed by the individual and mailed to the laboratory. The
results are mailed to the participant and the GP. If positive, the participant is
advised to visit his GP, where the participant is counselled and referred for
colonoscopy. This scenario is further called the mailing system .
Both scenarios will be presented for a target group aged 50-74 and a target
group aged 55-74. A distinction is made between the first round of screening
and the second and subsequent rounds of screening. This distinction is
important because the introduction of a previously non-existing screening
program induces a higher detection rate of cancer that will not be reached once
the program is running for several years.
The budget impact as well as the cost per CRC detected of both scenarios in
both age groups is estimated by means of an economic model. The analyses are
performed from a third payer perspective.
8.1.1 Baseline analysis: biennial screening with unrehydrated gFOBT
As most evidence is available in literature for a biennial screening strategy with
unrehydrated gFOBT, this will be our baseline analysis. Apart from data from
the literature (mostly for clinical variables), data from national databases (e.g.
for costs of procedures, population size) are used in the model. It is assumed
that, at the start of the screening program, half of the population in the target
group is being offered screening in the first year and the other half in the
second year. Therefore, the first screening round is defined as the first and
second year of the screening program, the second round as the third and fourth
year. Results are identical in the two years of the same screening round.