Ht ai2012 ccrDesign of implementation measures are extremely important to increase the participation rates and success of a population-based screening program

This document discusses the colorectal cancer screening program in the Basque Country. It achieved a high participation rate of 43% through measures like home delivery of screening kits, collection at health centers, and results communication to physicians and homes. The screening found premalignant and malignant lesions in 9.4% of participants. Colonoscopies on positive screens detected cancer in 3.9 per 1,000 and had a low complication rate of 1.09%. The screening program was found to be cost-effective.

Health & Medicine

Design of implementation measures are extremely
important to increase the participation rates and success of
a population-based screening program

Eunate Arana-Arria, Begoña Zuberoa, Isabel Portillob,
Isabel Idigorasb, José Ignacio Pijoana
Clinical Epidemiology Unit, Cruces University Hospital, Basque Health Service
a

Center Program Coordinator Colorectal Cancer Screening, Basque Health Service
b

CLORECTAL CANCER (CCR)
• Worldwide:
– Third most common cancer
– Fourth most common cause of cancer deaths
– 1.2 million estimated cases and 609,000 estimated deaths in 2008
• European Union (EU)
– Second most common newly-diagnosed cancer
– Second most common cause of cancer death
• Basque Country
– First cause of mortality
– Second cancer after:
 Breast
 Lung
• Mortality rates for the Basque Country (2006)
– 32.2/100,000 in men and 13.1/100,000 in women
(Rates adjusted to European Standard Population)

25/06/2012 2

COLORECTAL CANCER SCREENING
• European Code Against Cancer
“men and women aged 50 years or over
should participate in colorectal cancer screening”

25/06/2012 3

PREVENTION / SCREENING

The aim of colorectal cancer screening is to
improve prognosis by the detection of cancer
at its early stages

• PREVENTION:
– no smoking
– avoiding obesity
– doing regular physical exercise
– increasing the daily intake of fruits and vegetables
– limiting the consumption of foods containing animal fats

25/06/2012 4

CRC SCREENING PROGRAM
OF THE BASQUE COUNTRY

• Target population:
50-69 years (EU 2003 50 to 74)
• Fecal Occult Blood Test (FOBT):
– Every two years
– Cut-off 100 ng/ml
– Home delivery test
– Pick up at the health center
– Reference laboratory analysis
• FOBT POSITIVE:
Complete colonoscopy with deep sedation/anesthesia
• Coordinated Program
• Engaging Primary Care and Specialty Care
• Information System

25/06/2012 5

CCR SCREENING PROGRAM: 2009-2010

25/06/2012 6

PARTICIPATION RATES / POSITIVES
N= 28,300
N= 28,300 N= 11,266
N= 11,266 N= 116,980
N= 116,980

25/06/2012 7

PARTICIPATION AND POSITIVE RATES
By age group: males

25/06/2012 9

PARTICIPATION AND POSITIVE RATES
By age group: females

25/06/2012 10

Diagnostic confirmation: 4,492 colonoscopies

INDICATORS Results

Complete Colonoscopy Rate 90.8% (95% CI 90.0-91.6)

Low Grade Adenoma Detection Rate 9.9 x 1,000 (95% CI 9.2-10.6)

High Grade Adenoma Detection Rate 26.6 x 1,000 (95% CI 25.4-27.8)

Invasive Cancer Detection Rate 3.9 x 1,000 (95% CI 3.5-4.4)

25/06/2012 11

Diagnostic confirmation: result of colonoscopies

48%

%

25/06/2012 12

Complications of colonoscopies

INDICATORS Results

Complications rate 1.09% (95% IC 0.8-1.4)

Complications rate in the first
1.02% (95% IC 0.7-1.4)
colonoscopy

25/06/2012 13

COSTS

• Cancer detected:
7,324.38
• Premalignant and/or malignant lesion:
941.75
• Screened person:
28.71

25/06/2012 14

CONCLUSIONS
• REASONS FOR HIGH PARTICIPATION
RATES:

– Involvement of primary care physicians and nurses
– Submission of the kits to patients homes
– Delivery of the kits at the primary care settings with
open schedule
– Analysis of the sample in the reference hospital without
any frills or papers
– Results to primary care physicians and patients homes
– Public and universal health care system

25/06/2012 15

‫תודה‬

धनयवाद
спасибо Eskerrik
Asko

25/06/2012 16

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EVALUATION OF PSYCHOSOCIAL FACTORS INFLUENCING HEALTHCARE PROFESSIONAL ACCEPTANCE OF TELEMONITORING FOR CHRONIC PATIENTS Estibalitz Orruño1, Marie-Pierre Gagnon2-3, José Asua4, Eva Reviriego1 1 Basque Office for Health Technology Assessment (Osteba), Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain. 2 Faculty of Nursing Sciences, Université Laval, Québec, Canada. 3 Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada. 4 Direction of Knowledge Management and Evaluation, Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain.

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The document discusses improving opportunities for patient and consumer engagement in health technology assessment (HTA) in Australia. It notes that while mechanisms exist for patient input, the overall HTA process is not well understood, advocacy groups are under-resourced, and the timeline for submissions is short. It proposes the formation of HTA_AUS, a coalition of interested parties including patient groups, government, industry and others, to address this issue and develop practical solutions like supporting patient submissions and extending deadlines. The coalition aims to increase awareness, education and support for patient engagement in HTA.

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