Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study

Anita Lal; Lan Gao; Elise Tan; Nikki McCaffrey; David Roder; Elizabeth Buckley

doi:10.1371/journal.pone.0279177

Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study

PLoS One. 2022 Dec 21;17(12):e0279177. doi: 10.1371/journal.pone.0279177. eCollection 2022.

Authors

Anita Lal¹, Lan Gao¹, Elise Tan¹, Nikki McCaffrey^{1

2}, David Roder³, Elizabeth Buckley⁴

Affiliations

¹ Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
² Cancer Council Victoria, Melbourne, Victoria, Australia.
³ Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia.
⁴ Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.

Abstract

Introduction: The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA).

Methods: A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50-74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006-2013 using data linked to the SA Cancer Registry.

Results: We predict 10915 cases of CRC (95%CI: 8017─13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120─4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754─$15240) compared to Q5 $9281 ($6555─$12007). When substituting Q1 screening and diagnostic testing rates with Q5's, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1.

Conclusion: Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and follow-up tests for lower socioeconomic groups is critical to improve the health of these priority population groups.

Copyright: © 2022 Lal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenoma* / diagnosis
Adenoma* / epidemiology
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Early Detection of Cancer
Humans
Intestines
Mass Screening
Socioeconomic Factors
South Australia / epidemiology

Grants and funding

This study received financial support from the Australian National Data Service for data linkage and project activities. D.R. receives support from Cancer Council’s Beat Cancer Project on behalf of its donors. N.M is partly funded by the Cancer Council Victoria. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.