澳大利亚针对原住民和托雷斯海峡岛民进行定制化筛查以降低结直肠癌死亡率的潜力：建模研究。

The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: Modelling study.

机构信息

The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia.

Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.

出版信息

J Cancer Policy. 2022 Jun;32:100325. doi: 10.1016/j.jcpo.2022.100325. Epub 2022 Feb 8.

DOI:10.1016/j.jcpo.2022.100325

PMID:35560263

Abstract

BACKGROUND

Australian Aboriginal and Torres Strait Islander peoples experience health and socioeconomic disparities, including lower life-expectancy, have a younger mean age of colorectal cancer (CRC) diagnosis, and lower CRC survival than non-Indigenous Australians. The National Bowel Cancer Screening Program (NBCSP) provides biennial CRC screening for Australians aged 50-74 years to reduce the burden of CRC. The 2019 participation rate was 42% nationwide and 23% in Aboriginal and Torres Strait Islander peoples. For Aboriginal and Torres Strait Islander peoples, this study aims to estimate the health outcomes and cost-effectiveness of the current NBCSP and extensions to include people < 50 years.

METHODS

An existing microsimulation model, Policy1-Bowel, was adapted to the Aboriginal and Torres Strait Islander population and was used to evaluate three strategies assuming biennial iFOBT screening from 50-74, 45-74, or 40-74 years under two participation scenarios: 23% and 42% per screening round (psr.).

RESULTS

At 23-42% participation psr., the current NBCSP was predicted to reduce lifetime CRC incidence and mortality by 14-24% and 23-39%, respectively, be cost-effective (incremental cost-effectiveness ratio <$13,000/life-year saved), and be associated with a benefits-and-burden balance of 51-53 number-needed-to-colonoscope (NNC) per CRC death prevented of . Lowering the screening start age to 40(45) would further reduce CRC incidence and CRC mortality by 7-11(4-5) percentage points, be cost-effective, and be associated with an incremental NNC- of > 95 (> 60).

CONCLUSION

For Aboriginal and Torres Strait Islander peoples, the current NBCSP is cost-effective but participation is limited. Lowering the screening start age will further reduce CRC incidence and mortality.

POLICY SUMMARY

These findings highlight a need to increase NBCSP participation whilst exploring the feasibility and acceptability of lowering the NBCSP start age for Aboriginal and Torres Strait Islander peoples. These findings could inform new co-designed, community-led strategies to improve CRC outcomes for Aboriginal and Torres Strait Islander peoples.

摘要

背景

澳大利亚原住民和托雷斯海峡岛民在健康和社会经济方面存在差距，包括预期寿命较低、结直肠癌（CRC）诊断的平均年龄较小、CRC 生存率低于非原住民澳大利亚人。国家结直肠癌筛查计划（NBCSP）为 50-74 岁的澳大利亚人提供每两年一次的 CRC 筛查，以降低 CRC 的负担。2019 年，全国参与率为 42%，原住民和托雷斯海峡岛民为 23%。对于原住民和托雷斯海峡岛民，本研究旨在评估当前 NBCSP 的健康结果和成本效益，并扩展到包括<50 岁的人群。

方法

对现有的 Policy1-Bowel 微观模拟模型进行了改编，以适用于原住民和托雷斯海峡岛民人群，并用于评估三种策略，假设从 50-74、45-74 或 40-74 岁开始每两年进行一次 iFOBT 筛查，在两种参与率情景下（每轮筛查 23%和 42%）。

结果

在 23-42%的参与率下，当前的 NBCSP 预计将降低终生 CRC 发病率和死亡率 14-24%和 23-39%，具有成本效益（增量成本效益比<13,000 美元/人/年），并与 51-53 个结肠镜检查/每例 CRC 死亡的受益与负担平衡相关。将筛查起始年龄降低到 40（45）岁将进一步降低 7-11（4-5）个百分点的 CRC 发病率和 CRC 死亡率，具有成本效益，并与>95（>60）个的增量 NNC 相关。