Family history–based colorectal cancer screening in Australia: A modelling study of the costs, benefits, and harms of different participation scenarios

Background: The Australian National Bowel Cancer Screening Programme (NBCSP) was introduced in 2006. When fully implemented, the programme will invite people aged 50 to 74 to complete an immunochemical faecal occult blood test (iFOBT) every 2 years. Methods and findings: To investigate colorectal cancer (CRC) screening occurring outside of the NBCSP, we classified participants (n = 2,480) in the Australasian Colorectal Cancer Family Registry (ACCFR) into 3 risk categories (average, moderately increased, and potentially high) based on CRC family history and assessed their screening practices according to national guidelines. We developed a microsimulation to compare hypothetical screening scenarios (70% and 100% uptake) to current participation levels (baseline) and evaluated clinical outcomes and cost for each risk category. The 2 main limitations of this study are as follows: first, the fact that our cost-effectiveness analysis was performed from a third-party payer perspective, which does not include indirect costs and results in overestimated cost-effectiveness ratios, and second, that our natural history model of CRC does not include polyp sojourn time, which determines the rate of cancerous transformation. Conclusion: Investing in public health strategies to increase adherence to appropriate CRC screening will save lives and deliver high value for money. Driss Ait Ouakrim and colleagues present a microsimulation to compare hypothetical increased CRC screening scenarios to current participation levels in Australia, and evaluate clinical outcomes and costs for each risk category.Why was this study done?: What did the researchers do and find?: What do these findings mean?: