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Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland

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Show simple item record Sharp, Linda Tilson, Lesley Whyte, Sophie Ó Ceilleachair, Alan Walsh, Cathal Dominic Usher, Cara Tappenden, Paul Chilcott, James Staines, Anthony Barry, Michael Comber, Harry 2016-03-01T09:31:37Z 2016-03-01T09:31:37Z 2013
dc.identifier.citation Sharp, Linda and Tilson, Lesley and Whyte, Sophie and Ceilleachair, Alan O and Walsh, Cathal and Usher, Cara and Tappenden, Paul and Chilcott, James and Staines, Anthony and Barry, Michael and others (2013) 'Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland'. BMC health services research, 13 (1). en_US
dc.description peer-reviewed en_US
dc.description.abstract Background: Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods: A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results: FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions: While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning. en_US
dc.language.iso eng en_US
dc.publisher BioMed Central en_US
dc.relation.ispartofseries BMC Health Services Research;13: 105
dc.subject colorectal cancer en_US
dc.subject adenomatous polyps en_US
dc.subject mass screening en_US
dc.subject resource utilization en_US
dc.title Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US 2016-03-01T09:22:08Z
dc.description.version PUBLISHED
dc.contributor.sponsor HRB en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 1630586
dc.internal.copyrightchecked Yes
dc.description.status peer-reviewed

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