Table 1.
Outcomes for the three base-case recovery scenarios and sensitivity analyses compared with a scenario without disruption.
| Additional colonoscopies per month of recovery | ||||||||
|---|---|---|---|---|---|---|---|---|
| Length of disruption | Severity of disruptiona | Length of recovery | Preventiveg | Diagnostich | Excess cases | Excess deaths | Additional colonoscopies needed per month to prevent one deathi | |
| No disruptionb | 0 months | 0 months | None | |||||
| Base case analysis | ||||||||
| 12 months | Base-casec | 6 months | 590,100 (46.1%) | 16,600 (33.2%) | 3,810 (0.10%) | 4,190 (0.39%) | 180 | |
| 12 months | 260,200 (20.3%) | 6,700 (13.3%) | 5,590 (0.14%) | 4,580 (0.43%) | 66 | |||
| 24 months | 108,500 (8.3%) | 1,600 (3.2%) | 7,210 (0.18%) | 6,950 (0.65%) | Ref. | |||
| Scenario analysis | ||||||||
| 6 month disruption | 6 months | Base-casec | 6 months | 478,700 (38.0%) | 8,700 (16.2%) | 1.310 (0.03%) | 1,780 (0.17%) | 146 |
| 12 months | 230,300 (18.3%) | 2,500 (4.5%) | 2,930 (0.08%) | 2,850 (0.27%) | 84 | |||
| 24 months | 100,000 (7.8%) | -300 (-1.4%) | 6,290 (0.16%) | 4,430 (0.42%) | Ref. | |||
| 18 month disruption | 18 months | Base-casec | 6 months | 653,000 (51.4%) | 13,500 (27.8%) | 7,360 (0.19%) | 6,040 (0.57%) | 86 |
| 12 months | 313,400 (24.7%) | 3,900 (8.5%) | 11,050 (0.28%) | 8,090 (0.76%) | 45 | |||
| 24 months | 128,100 (10.0%) | -100 (0.2%) | 11,490 (0.29%) | 12,270 (1.16%) | Ref. | |||
| Lower severity of disruption | 12 months | Lower | 6 months | 379,100 (37.9%) | 9,800 (28.5%) | 3,310 (0.09%) | 3,290 (0.31%)f | 157 |
| 12 months | 165,000 (16.6%) | 3,500 (11.2%) | 3,970 (0.10%) | 3,270 (0.31%)f | 49 | |||
| 24 months | 67,500 (6.7%) | 600 (2.5%) | 5,820 (0.15%) | 5,330 (0.50%) | Ref. | |||
| Higher severity of disruption | 12 months | Higher | 6 months | 909,200 (70.7%) | 23,500 (45.6%) | 5,300 (0.14%) | 5,070 (0.48%) | 170 |
| 12 months | 399,500 (31.1%) | 9,700 (18.7%) | 7,560 (0.19%) | 5,800 (0.55%) | 63 | |||
| 24 months | 170,000 (13.1%) | 2,400 (4.5%) | 10,300 (0.26%) | 9,530 (0.90%) | Ref. | |||
| 10% no catch-up | 12 months | Base-casec | 6 months | 561,600 (44.7%) | 16,700 (30.1%) | 10,290 (0.26%) | 8,580 (0.81%) | 82 |
| 12 months | 238,800 (19.0%) | 6,700 (12.4%) | 13,780 (0.35%) | 9,290 (0.88%) | 30 | |||
| 24 months | 91,500 (7.3%) | 1,700 (3.1%) | 19,330 (0.50%) | 14,440 (1.36%) | Ref. | |||
| Sensitivity analysis | ||||||||
| 5% lower screening ratesd | 12 months | Base-casec | 6 months | 560,700 (47.0%) | 16,200 (31.0%) | 2,770 (0.07%) | 4,300 (0.38%) | 140 |
| 12 months | 247,300 (20.7%) | 6,600 (12.6%) | 5,220 (0.13%) | 5,030 (0.45%) | 56 | |||
| 24 months | 103,300 (8.7%) | 1,700 (3.2%) | 7,160 (0.18%) | 7,660 (0.68%) | Ref. | |||
| 5% higher screening ratesd | 12 months | Base-casec | 6 months | 612,000 (47.0%) | 17,100 (30.1%) | 2,780 (0.07%) | 3,190 (0.32%) | 162 |
| 12 months | 237,500 (20.7%) | 6,800 (12.2%) | 5,670 (0.15%) | 3,590 (0.36%) | 26 | |||
| 24 months | 113,900 (8.6%) | 1,600 (2.9%) | 7,240 (0.19%) | 6,410 (0.64%) | Ref. | |||
| Lower colorectal cancer riske | 12 months | Base-casec | 6 months | 595,600 (46.4%) | 15,800 (30.1%) | 3,960 (0.12%) | 3,830 (0.43%) | 130 |
| 12 months | 258,600 (20.1%) | 5,300 (10.1%) | 5,460 (0.17%) | 5,230 (0.59%) | 63 | |||
| 24 months | 106,100 (8.3%) | 1,400 (2.7%) | 8,830 (0.27%) | 7,720 (0.87%) | Ref. | |||
aSee Supplementary Table S1 for the severity of disruption levels.
bRequired capacity for the scenario without pandemic-induced delays was 15.1 million for preventive services and 0.6 million for diagnostic serviced. The model predicted 3.9 million colorectal cancer cases and 1.1 million colorectal cancer–related deaths.
cThe base-case severity of disruption was calculated from literature.
dCompared with a no disruption scenario with 5% lower/higher background screening rates.
eCompared with a no disruption scenario with a lower colorectal cancer risk.
fThe number of excess deaths for the 6 and 12-month recovery period are probably similar, but due to random variation the model estimated more deaths in case of a 6-month recovery period.
gScreening or surveillance procedures. Screening includes sigmoidoscopies and primary colonoscopies. Colonoscopy surveillance for patients with detected adenomas was based on US guidelines.
hDiagnostic colonoscopies following a positive FIT or colorectal cancer symptoms.
iIncluding some sigmoidoscopies. Ratios were subject to more (random) variation than the number or denominator alone. Caution in interpretation.