Abstract
Design
A microsimulation model will be developed to simulate a large number of individual life histories based on the New Zealand population and the epidemiology of colorectal cancer in NZ. Published guidelines and recommendations about CRC in NZ will then be applied to the model to determine the numbers of individuals who could benefit, and the health service requirements in three key areas:
- appropriate diagnosis, treatment and follow-up for people with CRC
- implementation of the NZ guidelines for the surveillance and management of individuals at increased risk of CRC
- CRC screening, if this were to be introduced in NZ.
The requirements for treatment, follow-up, surveillance, and screening determined by the microsimulation model will be informed by qualitative research into the perceptions of health professionals, patients, individuals at increased risk of CRC, and those likely to be eligible for screening should population screening be introduced in NZ. The perceptions and attitudes of health professionals and the wider public will provide important information about the likely acceptability and uptake of the guidelines for the early detection and treatment of CRC, and of screening in NZ.
The economic implications of CRC treatment, follow-up, surveillance, and screening will be investigated. This will involve weighing up costs and benefits of alternative strategies, including the status quo. NZ data on the costs associated with the diagnosis and investigation of those with CRC, treatment, follow-up and surveillance in NZ will be applied to the results from the microsimulation model to estimate the cost of full implementation of guidelines for treatment and follow-up of those with CRC, surveillance of those at increased risk, and the introduction of screening.
Main Outcome Measures
The model will produce the best possible estimates of the future burden of CRC in NZ (including estimates of the numbers of individuals who could benefit from screening, surveillance, and treatment), and the associated health service requirements. It will generate volumes for investigations and other procedures to which costs can be attached. This information will be invaluable for health service planning and prioritisation which will be essential for CRC control in NZ. The information provided by a unique multidisciplinary team of experienced independent academic researchers, will then allow evidence-based policy to be formulated by policymakers. The project will result in the development of a powerful research tool for NZ, where microsimulation modelling of the NZ population can be combined with epidemiological, clinical, economic and qualitative data for other diseases or health states, and used to determine the likely impact and health service requirements of interventions. Such interventions include the implementation of primary care initiatives, new guidelines for clinical care, and public health strategies including population screening programmes. In the first instance, the approach is being applied to CRC control in NZ, because information in this area is urgently needed.
Funding
Colorectal cancer control in New Zealand - HRC project grant for 3 years from September 2007.