The likely impact of earlier diagnosis of cancer on costs and benefits to the NHS

Overview This report presents a critical review of the five early awareness policy intervention models developed by Frontier Economics. For each issue highlighted within the review, the likely direction of the bias is discussed together with a suggestion of the extent to which these concerns could be rectified within the existing model structure.

Frontier Economics modelling approach The model sets out to address two specific questions:

1.How would the costs to the NHS change if certain cancers (specifically, breast, colorectal, lung, prostate and melanoma) were detected and diagnosed appreciably earlier than is currently the norm (i.e. according to current survival rates)?

2.How would the benefits to individuals change if these cancers were detected and diagnosed appreciably earlier than is currently the norm?

The model seeks to examine the impact that earlier detection and diagnosis would have on survival rates and on downstream costs and benefits. Benefits are limited to patient health benefits in terms of improved survival, i.e. change in life years. Costs include those that fall on the NHS, including diagnostics, screening, treatment, follow-up and end of life care.

The general approach is to produce projections under a set of assumptions relating to current incidence and screening rates, referred to as the „Business As Usual‟ (BAU) model. Also, to re-run this model making alternative assumptions about awareness and screening rates, referred to as the „Policy Intervention‟ scenario. The impact of earlier diagnosis is measured by comparing the two scenarios (BAU and Policy Intervention), where the key difference between the scenarios relates to the assumptions about the effectiveness of the awareness programme and the efficiency of the screening programme in the given cancer area (when there is screening programme in place - colorectal and breast).

The goal of the awareness programme is to inform the population about the risks of developing cancer and the signs that alert a patient to symptoms suspicious of underlying malignant disease. It is expected that individuals would present earlier to their GP, with the result that diagnosis will occur at an earlier stage of cancer, leading to higher survival rates. The early awareness programme seeks to achieve Europe‟s best practice survival rates, i.e. the group of comparable countries in Europe with the highest survival rates. The key assumptions in the model relating to the effectiveness of the awareness campaign and the efficiency of the screening programme, in terms of recruiting more individuals, are altered to achieve the target 1-year survival rates of EUROCARE-4 good practice.