A National Bowel Screening Programme Anticipated Colonoscopy Volumes Susan Parry Gastroenterologist, Clinical Director, MOH Bowel Cancer Programme Emmanuel.

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