LAUSR

BACKGROUND AND AIMS In July 2019, fecal immunochemistry testing (FIT) replaced fecal occult blood test (FOBt) in England as the Bowel Cancer Screening Program (BCSP) screening tool. We aimed to assess the impact of this on healthcare resources at our BCSP center. METHODS Two 6-month periods were initially analyzed for stool sample return and positivity rates. Subsequent comparative analysis of patient screening episodes assessed utilization of Specialist Screening Practitioner (SSP) time, endoscopy, histology, radiology, surgical, and oncology service usage. RESULTS A total of 42,234 patients received FOBt and 42,545 patients received FIT stool kits with FIT showing higher return (61.8% vs 58.58%, FIT vs FOBt, p <0.001) and sample positivity rates (2.41% vs 1.45%, FIT vs FOBt, p <0.001). Four hundred patients commenced FOBt and 616 FIT screening episodes: a 54% increase. The FIT group were of a lower mean age (67.5 vs 69.5 years old, FIT vs FOBt, p=0.0001) with a lower non-attendance rate (0.16% vs 1.5%, FIT vs FOBt, p=0.01). With higher patient numbers, the FIT group required 69% more endoscopic procedures, 58% increased SSP time, 40% more radiological tests and 68% higher surgical procedures. FIT also led to a 109% increase in endoscopy derived histology samples from an increase in the proportion of patients with polyps with FIT (54.8% vs 47.2%, p= 0.020) as well as a greater number of polyps per patient in whom polyps were found (3.00 vs 2.50 polyps, p=0.017). This additional service burden equated to additional financial costs of approximately $558,000 per annum. CONCLUSIONS The implementation of FIT led to notable increases on SSP time, endoscopy procedures, radiology tests, surgical procedures and histopathology services resulting in considerable ongoing financial implications on the organization. Findings can be used to aid workforce and service planning in NHS sites delivering BCSP and countries who have already adopted or are considering FIT within their national screening programs.