TY - JOUR
T1 - Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia
T2 - A modelling study
AU - Lal, Anita
AU - Gao, Lan
AU - Tan, Elise
AU - McCaffrey, Nikki
AU - Roder, David
AU - Buckley, Elizabeth
PY - 2022/12/21
Y1 - 2022/12/21
N2 - Introduction The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA). Methods A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50–74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006–2013 using data linked to the SA Cancer Registry. Results We predict 10915 cases of CRC (95%CI: 8017–13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120–4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754–$15240) compared to Q5 $9281 ($6555–$12007). When substituting Q1 screening and diagnostic testing rates with Q5’s, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1. Conclusion Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and followup tests for lower socioeconomic groups is critical to improve the health of these priority population groups.
AB - Introduction The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA). Methods A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50–74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006–2013 using data linked to the SA Cancer Registry. Results We predict 10915 cases of CRC (95%CI: 8017–13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120–4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754–$15240) compared to Q5 $9281 ($6555–$12007). When substituting Q1 screening and diagnostic testing rates with Q5’s, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1. Conclusion Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and followup tests for lower socioeconomic groups is critical to improve the health of these priority population groups.
KW - Bowel cancer screening
KW - Lower socioeconomic
KW - long-term health impacts
KW - Markov microsimulation
KW - socioeconomic quintile
KW - CRC colorectal cancer
KW - 50-74 years old
KW - South Australia
UR - http://www.scopus.com/inward/record.url?scp=85144593662&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0279177
DO - 10.1371/journal.pone.0279177
M3 - Article
C2 - 36542644
AN - SCOPUS:85144593662
SN - 1932-6203
VL - 17
JO - PLoS One
JF - PLoS One
IS - 12
M1 - e0279177
ER -