News Video | Policy | GPs | Hospitals | Medical | Mental Health | Welfare | Search


Bowel Cancer Screening Cost-Effective

Bowel-cancer screening cost-effective but does not reduce health inequalities

Bowel-cancer screening in New Zealand will improve health cost effectively, according to University of Otago research just published in the journal Cancer Epidemiology, Biomarkers and Prevention.

However, it will not improve ethnic inequalities in health.

University of Otago, Wellington, researchers used computer modelling to investigate health gains and found that the programme is very cost-effective for Māori and non-Māori, and for men and women.

“We simulated the effect of a faecal occult blood screening every two years for 50-74 year olds in New Zealand and found the health gains to be large,” says senior author Professor Tony Blakely from the Department of Public Health.

“For example, a non-Maori male aged 60-64 will on average expect to gain about 51 days of healthy life over the remainder of their life – even allowing for nearly half of people not taking up the programme.”

The screening costs the NZ health system about $2,930 (2011 values) per quality-adjusted life-year gained.

“As a general rule of thumb, an intervention costing less than about $50,000 per quality-adjusted life-year gained is considered a ‘good buy’ for society – so this is a ‘very good buy’,” Professor Blakely says.

Women gain a bit less.

The reason bowel cancer screening is so effective is that it not only detects pre-cancerous lesions (called polyps) and removes them, lowering cancer rates, but it can also detect cancer cases (if they develop) earlier.

“While it is unfortunate it has taken New Zealand some time to implement the bowel-cancer screening programme, it is also important to both congratulate the Government for now rolling it out and communicate to the public that this is a very worthwhile screening programme to take up,” says Professor Blakely.

“The New Zealand programme will be for 60-74 year olds, which makes sense given limited resources like colonoscopy services and that the programme is even more cost-effective for this narrower 60-74 year age range ($1,300 per quality-adjusted life-year gained) compared to 50-74 year olds ($2,930 per quality adjusted life year gained).

“But our study demonstrates that at some time in the future, if and when service capacity permits, it would be sensible to consider lowering the entry age to 50 years old.”

Lead author Dr Melissa McLeod says there is a potential down-side to bowel cancer screening.

Bowel cancer screening achieves less health gain for Māori than non-Māori mainly because Māori have lower rates of getting bowel cancer in the first place.

“So, although bowel-cancer screening will produce improvements in health for the entire population, it will slightly widen health inequalities for Māori,” says Dr McLeod.

“It is important, therefore, to increase bowel-cancer screening rates as much as is practical for Māori to lessen the inequality impacts. However, at the same time, we also know that if we want to reduce ethnic inequalities in health, we have to implement other policies that offer bigger gains in health for Māori, such as prevention policies for tobacco control and obesity reduction.

“In addition, we need to focus on other screening programmes that address cancers that occur in high rates in Māori, such as cervical cancer and stomach cancer,” says Dr McLeod.

For more detail, Public Health Expert Blog:

Table: Health gains for 60-64 year olds in 2011, starting a screening programme from ages 60 to 74 years old (i.e. what is currently being rolled out in NZ) [extracted from Table 4 of paper 1]

Sex Ethnic group Expected increase in quality adjusted life days lived over the remainder of one’s life Change in ethnic gap
Males Maori 51 days
Non-Maori 22 days -26 days *
Females Maori 44 days
Non-Maori 22 days -20 days

1 McLeod M, Kvizhinadze G, Boyd M, Barendregt J, Sarfati D, Wilson N, Blakely T. Colorectal cancer screening: How health gains and cost-effectiveness vary by ethnic group, the impact on health inequalities, and the optimal age-range to screen. Cancer Epidemiology Biomarkers & Prevention 2017.

* Not quite equal to 51 – 22 due to rounding of number to left in extraction from Table 4 of main paper


© Scoop Media

Culture Headlines | Health Headlines | Education Headlines

Kakī: World’s Rarest Wading Bird Released In Mackenzie Basin

Conservation Minister Maggie Barry says the birds will add to the 60 released into the Tasman valley earlier this month, significantly boosting the wild population. More>>


IHC Tribute: Colin Meads

"While Colin is best known for rugby, to us he is one of a small number of distinguished IHC New Zealand Life Members recognised for their significant support for people with intellectual disabilities," says IHC Chief Executive Ralph Jones. More>>


Howard Davis Review: Tilting at Turbines - The Trip to Spain

Steve Coogan and Rob Brydon have now both broken the Big Fifty barrier, which seems to have brought a whole new level of angst to their midlife adventures ... More>>

Review: A Rose By Any Other Name Would Smell As Sweet

The Royal New Zealand Ballet has accepted the challenge of this heart-touching tragedy and largely succeeded. More>>


NZ's First Male IAAF Gold: Tom Walsh's Historic Shot Put Victory

Although feeling very sore but with a great feeling Tom Walsh took his place as number one on the victory dais to receive his much deserved gold medal. More>>


Scoop Review Of Books: Q&A: Hard To Find Books

"Unfortunately we are in crisis and this friendly dinosaur faces extinction… Our only hope is to try and raise funds to buy the building and restore it to its glory, either fully funded or with a viable deposit." More>>



  • Wellington
  • Christchurch
  • Auckland