Abstract
BackgroundBreast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness and budget impact from 1996 to 2011.MethodsA discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess the impact of parameters uncertainty.ResultsThe actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY. All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health Service by 5.2 million euros from year 2000 onwards.ConclusionsThe BC screening programme in the Basque Country proved to be cost-effective during the evaluated period and determined an affordable budget impact. These results confirm the epidemiological benefits related to the centralised screening system and support the continuation of the programme.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2386-y) contains supplementary material, which is available to authorized users.
Highlights
Breast cancer screening in the Basque Country has shown 20 % reduction of the number of breast cancer (BC) deaths and an acceptable overdiagnosis level (4 % of screen detected BC)
Using discrete-event simulation an artificial entity is created for each woman included in the BC Screening Programme in the Basque Country (BCSPBC) and it is permitted to assign all kind of attributes to this entity in order to specify the evolution of that woman related to breast cancer and the correspondent effect of screening
The target population comprised multiple cohorts of women; women who were invited to the programme for the first time and successive invitations for those already included in the BCSPBC [7, 12], a multiple-cohort model was used to represent the whole population including women invited in different calendar years
Summary
Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). A great annual investment was assigned in order to obtain future health benefit During this period (1996–2011) the screening programme reduced 20 % the number of BC deaths whereas 4 % of screen detected BC were overdiagnosed, which has been found to be an acceptable level [1, 3]. Using discrete-event simulation an artificial entity is created for each woman included in the BCSPBC and it is permitted to assign all kind of attributes to this entity in order to specify the evolution of that woman related to breast cancer and the correspondent effect of screening. Allowing multi-cohort modelling is a key advantage of discrete-event simulation in order to carry out economic evaluation of public health programmes
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