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dc.contributor.authorLew JBen_AU
dc.contributor.authorSt John DJBen_AU
dc.contributor.authorMacrae FAen_AU
dc.contributor.authorEmery JDen_AU
dc.contributor.authorEe HCen_AU
dc.contributor.authorJenkins MAen_AU
dc.contributor.authorHe Een_AU
dc.contributor.authorGrogan Pen_AU
dc.contributor.authorCaruana Men_AU
dc.contributor.authorSarfati Den_AU
dc.contributor.authorGreuter MJEen_AU
dc.contributor.authorCoupé VMHen_AU
dc.contributor.authorCanfell Ken_AU
dc.date.issued2018
dc.date.issued2018en
dc.identifier.urihttps://hdl.handle.net/2123/30425
dc.description.abstractThe Australian National Bowel Cancer Screening Program (NBCSP) will fully roll‐out 2‐yearly screening using the immunochemical Faecal Occult Blood Testing (iFOBT) in people aged 50 to 74 years by 2020. In this study, we aimed to estimate the comparative health benefits, harms, and cost‐effectiveness of screening with iFOBT, versus other potential alternative or adjunctive technologies. A comprehensive validated microsimulation model, Policy1‐Bowel, was used to simulate a total of 13 screening approaches involving use of iFOBT, colonoscopy, sigmoidoscopy, computed tomographic colonography (CTC), faecal DNA (fDNA) and plasma DNA (pDNA), in people aged 50 to 74 years. All strategies were evaluated in three scenarios: (i) perfect adherence, (ii) high (but imperfect) adherence, and (iii) low adherence. When assuming perfect adherence, the most effective strategies involved using iFOBT (annually, or biennially with/without adjunct sigmoidoscopy either at 50, or at 54, 64 and 74 years for individuals with negative iFOBT), or colonoscopy (10‐yearly, or once‐off at 50 years combined with biennial iFOBT). Colorectal cancer incidence (mortality) reductions for these strategies were 51–67(74–80)% in comparison with no screening; 2‐yearly iFOBT screening (i.e. the NBCSP) would be associated with reductions of 51(74)%. Only 2‐yearly iFOBT screening was found to be cost‐effective in all scenarios in context of an indicative willingness‐to‐pay threshold of A$50,000/life‐year saved (LYS); this strategy was associated with an incremental cost‐effectiveness ratio of A$2,984/LYS–A$5,981/LYS (depending on adherence). The fully rolled‐out NBCSP is highly cost‐effective, and is also one of the most effective approaches for bowel cancer screening in Australia.en_AU
dc.publisherInternational Journal of Canceren_AU
dc.subject.otherCancer Type - Bowel Colorectal Canceren_AU
dc.subject.otherPrevention - Resources and Infrastructureen_AU
dc.titleEvaluation of the benefits, harms and cost‐effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australiaen_AU
dc.typeArticleen_AU
dc.identifier.doi10.1002/ijc.31314
dc.relation.otherKC receive salary support from the National Health and Medical Research Council of Australia (CDF #1082989)en_AU


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