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

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154 Screening for Colorectal Cancer: Appendices KCE reports vol.45 clearly illustrated in the literature review in chapter 6, it did not seem appropriate to attempt to model the current situation. The incremental cost of HemeSelect and Hemoccult II Sensa is high due to the high price of the first relative to the Hemoccult II and due to the increased number of colonoscopies generated by both. With the implementation of a mass screening program with one of those tests the demand for these tests will increase dramatically. This would offer the government the possibility to negotiate with the industry about the price of the tests. Lower prices will lower the expected budget impact and hence the average cost per CRC detected. 8.2.3 Sensitivity analysis The confidence intervals around the estimated costs of the different implementation scenarios are large due to the uncertainty in a number of modelling parameters. The relative impact of the uncertainty in the different modelling parameters on the estimated total cost of the screening program is illustrated by means of an influence diagram in figure 15 for the baseline analysis applying a mailing system. The lengths of the bars represent the relative importance of the variable for the results. They result from the 1000 Monte Carlo simulations ran on our model for the probabilistic sensitivity analysis. The by far most important uncertainty in all screening scenarios is participation. Uncertainty in the participation rate is the most decisive factor for the variability in the total cost estimate. In the mailing system also mailing costs, fixed campaign costs and compliance with colonoscopy after a positive FOBT influence the total cost estimate of mass screening for CRC. In the GP system the participation rate is the single most important uncertain factor in the model. participation rate mailing costs fixed campaign costs compliance with colonoscopy after positive FOBT 0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 Correlation coefficient Figure 15: Influence diagram, representing the sensitivity of the total cost estimate in the first screening round to uncertain modelling parameters in the mailing system (age group 50-74 years)
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 155 If we assume that our point estimate for participation is accurate, and fix this variable at the value of 45% in the GP system, where participation is the single most important uncertain factor, the most influential uncertain factors are (in order of importance): fixed campaign costs, mailing costs, compliance with colonoscopy after positive FOBT and positivity rate of FOBT in the first screening round. The uncertainty in the cost per CRC detected depends in first instance on the uncertainty in the detection rate of CRC after a positive FOBT in both the GP and mailing system. This was the most important factor in the GP system, whereas in the mailing system also the uncertainty around the participation rate, mailing costs, campaign costs and compliance with colonoscopy after positive FOBT added to the uncertainty in the cost per CRC detected (Figure 16). detection rate CRC participation rate mailing costs fixed campaign costs compliance w ith colonoscopy after positive FOBT Figure 16: Influence diagram representing the sensitivity of the estimated cost per CRC detected in the first screening round to uncertain modelling parameters in the mailing system (age group 50- 74 years) 8.3 CAPACITY NEEDS -0,8 -0,7 -0,6 -0,5 -0,4 -0,3 -0,2 -0,1 0 0,1 0,2 0,3 Correlation coefficients Implementing a mass screening program requires resources, not only in terms of money but also in terms of capacity. One of the major requirements is sufficient capacity to perform colonoscopies. From our baseline model with Hemoccult II, we concluded that 9890 colonoscopies per year would have to be performed in the first screening
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KCE reports vol.45A Colorectale Kan
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KCE reports 1. Effectiviteit en kos
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