Nurse-led virtual triage is cost effective for bowel cancer screening referrals for colonoscopy: An economic evaluation of direct access colonoscopy in New South Wales

Objective Assess costs and benefits to the New South Wales (NSW) health system and patients due to direct access colonoscopy (DAC) services from 2016 to 2023, plus 10-year projections, compared to the usual public hospital pathway. Methods Data were from linked hospital records, the National Cancer Screening Register and NSW Cancer Registry. Three evaluations were informed by data analyses and the literature: 1) healthcare costs for DAC, 2) patient travel costs/CO 2 savings, and 3) long-term modelling of costs/outcomes of DAC. Results DAC had an average wait time of 12 days less than public outpatient clinics, fewer patients waiting >120 days for colonoscopy (31.1% vs . 37.5%), and cost $115 more to the healthcare system than usual care but with 10-year projected savings of $46/patient. DAC as a change to care pathway did not directly produce better health outcomes but resulted in time/cost savings for patients and 4kg CO 2 equivalents saved for each in-person attendance avoided. Conclusions DAC is a cost-effective initiative that marginally reduces wait times for colonoscopy, with positive effects on patient time and finances, and a small net improvement in healthcare costs over time. Implications for Public Health DAC epitomises NSW Health’s shift to value-based health care, focusing on outcomes that matter most to patients: shorter wait times, convenient care, and earlier cancer detection.