S1 Table 1 Values of transition probability estimates and the 95% credible intervals for the natural history parameters; SFig 1 Model predicted versus observed average colorectal cancer mortality counts per year (2007-2010) by age, sex and ethnicity; SFig 2 Health systems cost inputs by Dukes stage and clinical phase (y-axis log scale) for males (female cost inputs available on request from author); STable 2 Model validation: percentage reduction (95% confidence or uncertainty interval) in colorectal cancer mortality in MSLT model, selected RCTs and selected other simulation models; SFig 3 Tornado plots* for one-way sensitivity analyses of the total population incremental cost-effectiveness ratio (ICER †); STable 3 Optimal CRC screening age-range for M�ori; STable 4 Optimal CRC screening age-range for non-M�ori
ARTICLE ABSTRACT
Background: Screening programs consistently underserve indigenous populations despite a higher overall burden of cancer. In this study, we explore the likely health gains and cost-effectiveness of a national colorectal cancer screening program for the indigenous Māori population of New Zealand (NZ).Methods: A Markov model estimated: health benefits (quality-adjusted life-year; QALY), costs, and cost-effectiveness of biennial immunochemical fecal occult blood testing (FOBTi) of 50- to 74-year-olds from 2011. Input parameters came from literature reviews, the NZ Bowel Screening Programme Pilot, and NZ linked health datasets. Equity analyses substituted non-Māori values for Māori values of background (noncolorectal cancer) morbidity and mortality, colorectal cancer survival and incidence, screening coverage, and stage-specific survival. We measured the change in “quality-adjusted life expectancy” (QALE) as a result of the intervention.Results: Based upon a threshold of GDP per capita (NZ$45,000), colorectal cancer screening in NZ using FOBTi is cost-effective: NZ$2,930 (US$1,970) per QALY gained [95% uncertainty interval: cost saving to $6,850 (US$4,610)]. Modeled health gains per capita for Māori were less than for non-Māori: half for 50- to 54-year-olds (0.031 QALYs per person for Māori vs. 0.058 for non-Māori), and a fifth (0.003 c.f. 0.016) for 70- to 74-year-olds and ethnic inequalities in QALE increased with colorectal cancer screening.Conclusions: Colorectal cancer screening in NZ using FOBTi is likely to be cost-effective but risks increasing inequalities in health for Māori.Impact: To avoid or mitigate the generation of further health inequalities, attention should be given to underserved population groups when planning and implementing screening programs. Cancer Epidemiol Biomarkers Prev; 26(9); 1391–400. ©2017 AACR.
