A National Bowel Screening Programme Anticipated Colonoscopy Volumes Susan Parry Gastroenterologist, Clinical Director, MOH Bowel Cancer Programme Emmanuel Jo Principal Technical Specialist, Health Workforce NZ, MOH Helen Gower Principal Advisor Cancer Information, Bowel and Prostate Cancer

Positivity in the BSP Round 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 2 CRC detection rate DR/1000 screened 2.8 ( ) 1.3 Advanced adenoma DR Adenoma DR 36.9 ( ) 22.8 PPV CRC % 4.2 ( ) 2.6 PPV Advanced adenoma % PPV adenoma % 56.1 ( ) 46.5 Numbers cancers found(private)186 (22) 42 (5) Those with low risk adenoma returned to screening Remainder offered ongoing colonoscopic surveillance

Assumes 20% increase in symptomatic referrals over first two years of screening

National roll out as per WDHB (age yrs.)

National roll out as per WDHB (age yrs.) Pink block represents colonoscopy shortfall

Past and present colonoscopy wait time indicators

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

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 years at various Hb concentration cut-offs * as at May 2015 Advanced adenoma > 10mm, high grade dysplasia, villous component

National implementation from 2017 Age yrs. adjusted FIT threshold

National implementation from 2017 Age yrs. adjusted FIT threshold Pink block represents colonoscopy shortfall

National implementation from 2017 Age 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