Journal
INTERNATIONAL JOURNAL OF CANCER
Volume 151, Issue 2, Pages 287-296Publisher
WILEY
DOI: 10.1002/ijc.34000
Keywords
breast cancer; cost-effectiveness; mass screening; microsimulation modelling; screening strategies
Categories
Funding
- Centre for Population Screening (CvB) of the Dutch National Institute for Public Health and the Environment (RIVM) as part of the Dutch National Evaluation Team for Breast cancer screening (NETB)
- Cancer Intervention and Surveillance Modelling Network (CISNET)
Ask authors/readers for more resources
This study evaluates the cost-effectiveness of breast cancer screening strategies in the Netherlands and finds that switching from biennial to triennial screening, with a lower starting age of 44, can increase benefits at lower costs.
Breast cancer screening policies have been designed decades ago, but current screening strategies may not be optimal anymore. Next to that, screening capacity issues may restrict feasibility. This cost-effectiveness study evaluates an extensive set of breast cancer screening strategies in the Netherlands. Using the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model, the cost-effectiveness of 920 breast cancer screening strategies with varying starting ages (40-60), stopping ages (64-84) and intervals (1-4 years) were simulated. The number of quality adjusted life years (QALYs) gained and additional net costs (in euro) per 1000 women were predicted (3.5% discounted) and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Sensitivity analyses were performed using different assumptions. In total, 26 strategies covering all four intervals were on the efficiency frontier. Using a willingness-to-pay threshold of euro20 000/QALY gained, the biennial 40 to 76 screening strategy was optimal. However, this strategy resulted in more overdiagnoses and false positives, and required a high screening capacity. The current strategy in the Netherlands, biennial 50 to 74 years, was dominated. Triennial screening in the age range 44 to 71 (ICER 9364) or 44 to 74 (ICER 11144) resulted in slightly more QALYs gained and lower costs than the current Dutch strategy. Furthermore, these strategies were estimated to require a lower screening capacity. Findings were robust when varying attendance and effectiveness of treatment. In conclusion, switching from biennial to triennial screening while simultaneously lowering the starting age to 44 can increase benefits at lower costs and with a minor increase in harms compared to the current strategy.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available