Abstract
BackgroundThe Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models.MethodsWe applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out.ResultsThe goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards.ConclusionsThis economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis.
Highlights
The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013
In Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis
Sensitivity analysis To assess the impact of model assumptions in our results, three main sensitivity analyses were carried out: 1) A scenario including a lower prevalence of adenomas based on the literature [31,32,33,34,35,36,37,38,39,40] was run in addition to the base case model; 2) Because individuals with a false negative test result have a higher than average probability of another false negative test result at a successive screening, we developed a new scenario in which dependency of faecal immunochemical testing (FIT) results in sequential screening rounds was assumed (Additional file 2: Table S2) [41]; 3) The impact of increasing the cost of screening was estimated
Summary
The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. Specific evaluations for different programmes are necessary because local CRC epidemiology (cancer incidence and adenoma prevalence) and the actual implementation of screening (type of test, attendance rate, and surveillance schedule) can cause variations in efficiency [4,5,6]. CRC in Basque country is characterized by unusual epidemiological features given that CRC incidence is similar to other European countries while adenoma prevalence is higher [7]. The Basque CRC epidemiology of high adenomas prevalence may constitute a challenge because it may mean that the number of colonoscopies required in the CRC screening programme will be higher. Experts have underscored the need to tailor the implementation of CRC screening in populations within the context of organized programmes [6, 15]
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