A National Bowel Screening Programme Anticipated Colonoscopy Volumes Susan Parry Gastroenterologist,...
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Transcript of A National Bowel Screening Programme Anticipated Colonoscopy Volumes Susan Parry Gastroenterologist,...
A National Bowel Screening Programme
Anticipated Colonoscopy VolumesSusan Parry
Gastroenterologist, Clinical Director,
MOH Bowel Cancer Programme
Emmanuel JoPrincipal Technical Specialist,
Health Workforce NZ , MOH
Helen GowerPrincipal Advisor
Cancer Information, Bowel and Prostate Cancer
Positivity in the BSPRound 1 and the first year of Round 2
Round 1 results:
Between 1 January 2012 and 31 December 2013:*
• Over 121,000 eligible people invited to take part in the Pilot
• Coverage 97.5% (based on census data)
• The programme participation rate was 55.8%
• Overall positivity rate was 7.5%
• 96% of those with a +ve FIT went to colonoscopy
• CRCs found in 186 (22) people (46.2% TNM Stage 1)
* Data pulled March 2015
Bowel Screening Pilot results to Dec 2014* pulled March 2015
Rd 1 Rd 2CRC detection rate DR/1000 screened 2.8 (1-8-9.5)
1.3
Advanced adenoma DR 15.9 7.5
Adenoma DR 36.9 (13.3-22.3)
22.8
PPV CRC % 4.2 (4.5-
8.6) 2.6
PPV Advanced adenoma % 24.2 15.2
PPV adenoma % 56.1 (9.6-40.3) 46.5
Numbers cancers found (private) 186 (22) 42 (5)
Those with low risk adenoma returned to screening
Remainder offered ongoing colonoscopic surveillance
Parameters from Waitemata DHB Pilot ProjectStatistics New Zealand
Population Projection
Workforce Capacity Projection by HWNZ
CT Colonography Capacity
DHB Specific Capacity and Projection
The National Bowel Screening Programme Model
Literature Review
Assumes 20% increase in symptomatic referrals over first two years of screening
National roll out as per WDHB (age 50-74 yrs.)
National roll out as per WDHB (age 50-74 yrs.)Pink block represents colonoscopy shortfall
Past and present colonoscopy wait time indicators
Waiting time indicator classification Criteria 2012/13 2013/14 2014/15 2015/16*Urgent Received or waiting less than 14 days 50% 50% 75% 75%Non urgent Received or waiting less than 42 days 50% 50% 60% 65%Surveillance Received or waiting less than 84 days 50% 50% 60% 65%
Waiting time indicator classification
Numerator
Urgent Received or waiting less than 14 days
Non urgent Received or waiting less than 42 days
Surveillance Received or waiting less than 84 days
Total patients waiting who have received an urgent colonoscopy or waiting for an urgent colonoscopy
Total patients waiting who have received an surveillance colonoscopy or waiting for an surveillance colonoscopy (past the planned date)
Total patients waiting who have received a non urgent colonoscopy or waiting for a non urgent colonoscopy
Denominator
Target
National progress in timely colonoscopy delivery
Colonoscopy: numbers performed July 2012-May 2015
Colonoscopy: numbers waiting July 2012 to May 2015
Number of colonoscopies performed
Q1 Q2 Q3 Q4 Total2012/13 8,703 7,044 6,864 7,511 30,122 2013/14 7,725 6,930 7,396 10,273 32,324 2014/15 8,859 9,290 8,809 9,118 36,076
18 184 20
18 2322 1732 1053 16
17% 27 1712 1719 16-1 15
-17% -17 8
Number performed
Q1Q1
Q1Q2 Q2
Q2
Q3 Q3Q3
Q4
Q4Q4
-
2,000
4,000
6,000
8,000
10,000
12,000
2012/13 2013/14 2014/15
Nu
mb
ers
pe
rfo
rme
d
Colonoscopies performed by financial year
May 2015 results: Urgent colonoscopy indicator
May 2015 results: Non urgent colonoscopy indicator
May 2014 results: Non urgent colonoscopy indicator
May 2015 results: Surveillance colonoscopy indicator
CTC numbers performed by DHB Jan – May 2015
Colonoscopy capacity planning
• Requires time
• Aware that DHBs doing their own modelling of potential demands based on WDHB BSP parameters to plan capital & workforce requirements
• With the availability of Round 1 data opportunity to determine feasible phased roll out options
• Now able to share with DHBs these estimates of potential maximum colonoscopy volumes associated with a phased roll out from early 2107
• Will inform consultation and business case
Table 1: For age group 50-74 years at various Hb concentration cut-offs * as at May 2015
Advanced adenoma > 10mm, high grade dysplasia, villous component
Cut-off for positivity
ng/mL buffer 75 100 150 200 250µg Hb/g feces 15 20 30 40 50
Positivity 7.5% 6.3% 5.0% 4.2% 3.7%
PPV CRC 4.2% 4.6% 5.4% 6.1% 6.7%
PPV AdA 24.3% 26.1% 28.4% 33.6% 34.5%
CRC DR/1,000 screened 2.72 2.53 2.36 2.27 2.17
Reduction in colonoscopy (%) Ref 15.9% 32.8% 43.2% 50.4%
CRC (% detected) Ref 93.0% 86.6% 83.3% 79.6%
50-74 yrs
National implementation from 2017 Age 60-74 yrs. adjusted FIT threshold
National implementation from 2017 Age 60-74 yrs. adjusted FIT thresholdPink block represents colonoscopy shortfall
National implementation from 2017 Age 60-74 yrs. adjusted FIT threshold- example DHB
National implementation from 2017 Age 60-74 yrs. adjusted FIT threshold- example DHB
National implementation from 2017 Age 60-74 yrs. adjusted FIT threshold- example DHB
Conclusion
Colonoscopy volumes are estimates only and may change with
• Final results round 2
• Colonoscopy volumes in 2016/2017
• Final evaluation/cost effectiveness analyses
Aim to
• Maximise cancer detection within potentially available colonoscopy resource
• Minimise unnecessary colonoscopies for participants
• Maintain timely high quality symptomatic/surveillance procedures