Nurse-led virtual triage is cost effective for bowel cancer screening referrals for colonoscopy: An economic evaluation of direct access colonoscopy in New South Wales

Objective: Assess costs and benefits to the New South Wales (NSW) health system and patients due to direct access colonoscopy (DAC) services from 2016 to 2023, plus 10-year projections, compared to the usual public hospital pathway. 

Methods: Data were from linked hospital records, the National Cancer Screening Register and NSW Cancer Registry. Three evaluations were informed by data analyses and the literature: 1) healthcare costs for DAC, 2) patient travel costs/CO₂ savings, and 3) long-term modelling of costs/outcomes of DAC. 

Results: DAC had an average wait time of 12 days less than public outpatient clinics, fewer patients waiting >120 days for colonoscopy (31.1% vs. 37.5%), and cost $115 more to the healthcare system than usual care but with 10-year projected savings of $46/patient. DAC as a change to care pathway did not directly produce better health outcomes but resulted in time/cost savings for patients and 4kg CO₂ equivalents saved for each in-person attendance avoided. 

Conclusions: DAC is a cost-effective initiative that marginally reduces wait times for colonoscopy, with positive effects on patient time and finances, and a small net improvement in healthcare costs over time. 

Implications for Public Health: DAC epitomises NSW Health's shift to value-based health care, focusing on outcomes that matter most to patients: shorter wait times, convenient care, and earlier cancer detection.