Extension of BowelScreen to Ages 50-54: A Cost-Effectiveness Analysis

Introduction

Colorectal cancer, commonly known as bowel cancer, affects the lower part of the bowel, including the colon and rectum. Globally, colorectal cancer is the third most commonly diagnosed cancer, accounting for about 10% of all cancer cases in 2020, with over 1.8 million new cases. In Ireland, it is the second most frequently occurring cancer in males and the third in females, with an annual average of 2,562 new cases between 2018 and 2020. Extending BowelScreen to individuals aged 50 to 54 years is a topic of significant interest in Ireland. A recent report explores the cost-effectiveness of this extension done by the Health Information and Quality Authority (HIQA), focusing on the Irish context.

Current Screening Practices

BowelScreen currently targets individuals aged 55 to 74 years. This age group has an average risk for colorectal cancer. The screening uses the Faecal Immunochemical Test (FIT), which detects blood in the stool. Early detection through screening can lead to better outcomes and reduced mortality rates. Therefore, the programme has been successful in identifying cases of colorectal cancer early, allowing for timely intervention and treatment.

Proposed Extension to Younger Age Group

The proposal suggests extending BowelScreen to individuals aged 50 to 54 years. This extension aims to detect colorectal cancer earlier in this at-risk age group. Moreover, early detection can boost survival rates significantly. The extension would involve using the same FIT-based strategies currently in place for the older age group. By lowering the starting age for screening, the programme hopes to identify more cases of colorectal cancer at an earlier, more treatable stage.

Cost-Effectiveness of BowelScreen extension

To determine the cost-effectiveness of this extension, a review of existing studies was conducted. The review focused on European studies, as these are most likely to be transferable to the Irish context. The primary metric used was the Incremental Cost-Effectiveness Ratio (ICER), which measures the cost per quality-adjusted life year (QALY) gained. The analysis considered various factors, including the costs of screening, follow-up procedures, and treatment, as well as the potential savings from early detection and reduced cancer treatment costs.

Findings and Implications

The review found that extending BowelScreen to those aged 50 to 54 years is likely to be cost-effective. The ICERs for this age group were within the willingness-to-pay thresholds of €20,000 and €45,000 per QALY gained, which are typically used in Ireland. This suggests that the benefits of early detection outweigh the costs. The analysis also highlighted the potential for significant public health benefits, including reduced mortality rates and improved quality of life for individuals diagnosed with colorectal cancer at an earlier stage.

Anticipated Timeline

Firstly, the cost-effectiveness of BowelScreen extension will be submitted to the Board of HIQA for approval. Upon approval, the final health technology assessment (HTA) and associated Statement of Outcomes will be submitted to the National Screening Advisory Committee (NSAC) for consideration and published on the HIQA website. The anticipated completion date is Q2 2025.

Conclusion

Extending BowelScreen to individuals aged 50 to 54 years is a cost-effective strategy. It can lead to earlier detection of colorectal cancer, improving survival rates and reducing healthcare costs in the long run. This extension aligns with the goals of value-based healthcare, focusing on outcomes and cost-efficiency. By investing in early detection, the healthcare system can save on the costs associated with advanced cancer treatment and improve patient outcomes.