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Developing and using a tool to improve outcomes in colorectal cancer

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With rising demand for health services putting pressure on resources, it is more important than ever to make sure services are cost-effective and efficient.

Sharing knowledge and experience of new and innovative ways of working can help make sure the money we spend produces the best health outcomes for people.

Public health professionals can help to analyse data and pull out the most useful evidence to support funding decisions for different services.

By looking at the evidence we have on treatments and interventions, and the evidence provided by our partners across the NHS, we can make the right decisions when it comes to investing precious resources.

We were able to put this into practice when the Specialised Services directorate of NHS England, which funds all cancer chemotherapy treatments, asked PHE to help them drive improved outcomes from chemotherapy – the most expensive treatment they fund.

PHE and NHS England have a vast amount of data and data sources, some of which are presented using online tools that allow local authorities and clinical commissioning groups (CCGs) to compare their performance.

We set up a working group to identify indicators that correspond with the chemotherapy pathway, including both causes of cancer and survival rates.

From this, we took a tool that already existed to calculate return on investment and used it to create a new one that relates specifically to colorectal cancer (CRC): the CRC ROI tool.

How did we make a return on investment tool?

It’s important that we frequently look over the data tools we have to ensure they are giving users what they need and that they meet the needs of services.

The tool draws on existing information on costs and interventions as well as CCG specific data to estimate the costs and benefits to commissioners and to the wider health system.

There are four types of data needed to produce the desired outputs: CCG performance, the number of people diagnosed, the cost of the pathway and the interventions to increase early diagnosis.

A number of publicly available sources from Public Health England and the Department of Health were used to identify metrics such as survival rates, screening levels, and diagnostic capacity.

We provided an extract from our Cancer Analysis System (CAS) database with summary information about each CCG population that described the number of diagnoses by stage and route to diagnosis.

This work draws on five extensive analyses of CRC pathway costs in England prepared since 2004, with the most recent published this year.

The primary source of cost data in the tool is the 2014 Cancer Research UK/Incisive paper, ‘Saving lives and averting costs’.

Finally, evidence on interventions was collected through a search of the available literature on interventions to increase the effectiveness of screening.

What does the tool offer?

The user-friendly tool enables organisations at a local level to estimate the costs and benefits of improving outcomes in bowel cancer. The tool’s output can help local commissioners to answer:

  • How is my CCG performing today?
  • What is the health gain associated with earlier bowel cancer intervention?
  • What is the economic impact associated with earlier bowel cancer intervention?

The tool uses the CCG’s own data to estimate the benefits (in terms of fewer late presentations) that could accrue over time from diagnosing people earlier. The primary goal is to diagnose more people at an earlier stage.

The final output of the tool is a calculation of economic impact and estimated health benefit. The tool is accompanied by a report which brings together what is known about the costs of CRC across the care pathway, linking to NHS England’s work on defining the optimal care pathway, that aims to ‘shift the curve’ towards earlier detection and diagnosis.

An example of the CRC ROI tool in action

Colorectal cancer accounts for one out of nine cancer cases in England and an estimated 14,000 deaths in 2014.

The five-year survival rates for CRC in England are worse than in peer countries, and this gap has not closed significantly over time unlike those for breast and ovarian cancers.

Cambridge and Peterborough CCG covers a population of 955,000 in the East of England. Figure 1, and using the tool, we can see that they were not performing as well as they might be for the percentage of those aged 60-69 years of age who were screened for bowel cancer in the previous 30 months.

The tool also allows us to look at the additional number (4,430) of people they would need to screen in order to bring the percentage up to the levels of the best five CCGs in its peer comparator group.

How can the tool be used for commissioning?

This tool should be extremely useful to build up a picture of factors influencing outcomes for CRC and to help make the case for investment in earlier diagnosis of bowel cancer.

The example above from Cambridge and Peterborough CCG shows that sometimes money needs to be spent in order to improve outcomes.

The CRC ROI tool provides information that helps commissioners to make the business case for appropriate investment to improve early detection.

However, making cost-effective decisions is not necessarily the same as cost saving. Decisions on interventions are made to maximise health benefits with the ultimate aim of saving lives rather than to save money overall.

If you need more information on using the tool please email

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