Nicole Mittmann1, Natasha K Stout1, Anna N A Tosteson1, Amy Trentham-Dietz1, Oguzhan Alagoz1, Martin J Yaffe1. 1. Affiliations: Sunnybrook Research Institute (Mittmann), Sunnybrook Health Sciences Centre; Department of Pharmacology and Toxicology (Mittmann), University of Toronto, Toronto, Ont.; Department of Population Medicine (Stout), Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.; Dartmouth Institute for Health Policy and Clinical Practice (Tosteson), Geisel School of Medicine, Dartmouth College, Hanover, NH; Department of Population Health Sciences and Carbone Cancer Center (Trentham-Dietz, Alagoz); Department of Industrial and Systems Engineering (Alagoz), University of Wisconsin-Madison, Madison, Wisc.; Physical Sciences Program (Yaffe), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre; Departments of Medical Biophysics and Medical Imaging (Yaffe), University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: The implementation of population-wide breast cancer screening programs has important budget implications. We evaluated the cost-effectiveness of various breast cancer screening scenarios in Canada from a publicly funded health care system perspective using an established breast cancer simulation model. METHODS: Breast cancer incidence, outcomes and total health care system costs (screening, investigation, diagnosis and treatment) for the Canadian health care environment were modelled. The model predicted costs (in 2012 dollars), life-years gained and quality-adjusted life-years (QALYs) gained for 11 active screening scenarios that varied by age range for starting and stopping screening (40-74 yr) and frequency of screening (annual, biennial or triennial) relative to no screening. All outcomes were discounted. Marginal and incremental cost-effectiveness analyses were conducted. One-way sensitivity analyses of key parameters assessed robustness. RESULTS: The lifetime overall costs (undiscounted) to the health care system for annual screening per 1000 women ranged from $7.4 million (for women aged 50-69 yr) to $10.7 million (40-74 yr). For biennial and triennial screening per 1000 women (aged 50-74 yr), costs were less, at about $6.1 million and $5.3 million, respectively. The incremental cost-utility ratio varied from $36 981/QALY for triennial screening in women aged 50-69 versus no screening to $38 142/QALY for biennial screening in those aged 50-69 and $83 845/QALY for annual screening in those aged 40-74. INTERPRETATION: Our economic analysis showed that both benefits of mortality reduction and costs rose together linearly with the number of lifetime screens per women. The decision on how to screen is related mainly to willingness to pay and additional considerations such as the number of women recalled after a positive screening result. Copyright 2018, Joule Inc. or its licensors.
BACKGROUND: The implementation of population-wide breast cancer screening programs has important budget implications. We evaluated the cost-effectiveness of various breast cancer screening scenarios in Canada from a publicly funded health care system perspective using an established breast cancer simulation model. METHODS:Breast cancer incidence, outcomes and total health care system costs (screening, investigation, diagnosis and treatment) for the Canadian health care environment were modelled. The model predicted costs (in 2012 dollars), life-years gained and quality-adjusted life-years (QALYs) gained for 11 active screening scenarios that varied by age range for starting and stopping screening (40-74 yr) and frequency of screening (annual, biennial or triennial) relative to no screening. All outcomes were discounted. Marginal and incremental cost-effectiveness analyses were conducted. One-way sensitivity analyses of key parameters assessed robustness. RESULTS: The lifetime overall costs (undiscounted) to the health care system for annual screening per 1000 women ranged from $7.4 million (for women aged 50-69 yr) to $10.7 million (40-74 yr). For biennial and triennial screening per 1000 women (aged 50-74 yr), costs were less, at about $6.1 million and $5.3 million, respectively. The incremental cost-utility ratio varied from $36 981/QALY for triennial screening in women aged 50-69 versus no screening to $38 142/QALY for biennial screening in those aged 50-69 and $83 845/QALY for annual screening in those aged 40-74. INTERPRETATION: Our economic analysis showed that both benefits of mortality reduction and costs rose together linearly with the number of lifetime screens per women. The decision on how to screen is related mainly to willingness to pay and additional considerations such as the number of women recalled after a positive screening result. Copyright 2018, Joule Inc. or its licensors.
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