Wider use of colonoscopy could improve outcomes in bowel cancerBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39370.652245.13 (Published 18 October 2007) Cite this as: BMJ 2007;335:795
Increasing the use of colonoscopy to investigate potential cases of bowel cancer could help to improve outcomes in people with the disease while also reducing costs, suggest the results of an economic modelling study.
The study, commissioned by the Department of Health, looked at the costs of different aspects of managing bowel cancer in England and also at how developing bowel cancer services in different ways could affect costs and benefits for patients. The findings will feed into a review of cancer services by the department.
Bowel cancer is the third most common cancer in England; 27 800 new cases were diagnosed in 2003. Five year survival rates are less than 50%, partly due to the large proportion of late diagnoses.
Researchers at the York Health Economics Consortium at the University of York and the School of Health and Related Research at the University of Sheffield have estimated that it costs the NHS in England £1.1bn ($2.3bn; €1.6bn) a year to manage bowel cancer services, including screening. A breakdown of expenditure found that the single biggest cost to the NHS was for diagnostic services, which totalled £290m annually, most (£270m) for tests in people who turn out not to have cancer.
The researchers looked at 14 potential options for improving the detection, diagnosis, and treatment of bowel cancer that could be introduced into the NHS in England. For example, they looked at whether improving the criteria by which GPs referred patients for investigation or whether switching to preoperative instead of postoperative radiotherapy would help to improve outcomes. They then devised a model which they used to estimate the expected costs of each option and the potential gains in terms of quality adjusted life years (QALYs).
The analysis found that the most economically attractive option for improving outcomes for bowel cancer patients is to increase the use of colonoscopy from 70% of patients who present with suspicious symptoms to 90%. Currently about 30% of patients referred for investigation have flexible sigmoidoscopy, which the report says has a greater chance of missing cancer than does colonoscopy. “Whilst the assumptions in the model may affect the extent to which this option will benefit patients, it is expected to improve health outcomes and produce cost savings,” says the report.
Introducing an enhanced recovery programme into the NHS for patients undergoing surgery for bowel cancer is also likely to result in reduced costs, the report says.
Other options which have the potential to improve health outcomes at a relatively low cost include improving surgical resection or pathology, or both, and improving adjuvant or palliative chemotherapies, provided that the regimens are not considerably more expensive than current standard chemotherapies.
The model suggests that further developing the criteria by which GPs refer patients for investigation for bowel cancer has the potential to improve outcomes, but more research is needed to ensure that “specificity is not decreased as a result of increasing sensitivity since this would lead to worsened health outcomes,” says the report.
The report, Bowel Cancer Services: Costs and Benefits, can be seen at www.yhec.co.uk
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