Systematic Review of the Cost Effectiveness of Breast Cancer Prevention, Screening, and Treatment Interventions.

Abstract

It has been nearly 5 decades since Congress passed the 1971 National Cancer Act to strengthen the National Cancer Institute’s ability to eliminate the suffering from cancer.1 Most early efforts of the National Cancer Institute focused on development of cancer therapeutics. Later, Congress passed the 21st Century Cancer Access to Life-Saving Early Detection, Research and Treatment Act to increase the national research focus on prevention and early detection.2 Data from this period in US health care history suggest that the investments in prevention, screening, and treatment have together reduced cancer mortality by 27% over the past quarter of a century.3 The present era holds the promise to further reduce mortality with an explosion of scientific discoveries and new technologies based on knowledge about personal, lifestyle, genetic, and molecular disease factors.4-9 Although these recent advances have the potential to avoid cancer incidence,10 detect cancer earlier, and/or improve cancer survival, it has become increasingly complex to determine which intervention has the best value or the greatest improvement in health outcomes for the US population at the most reasonable and affordable costs.11,12 Economic evaluation provides data on several aspects of cancer care that can be used to address discussions about value and inform policies and guidelines.13,14 Cost-effectiveness analysis is the most common economic evaluation tool currently used to inform public health policy decisions, resource allocation, and investment decisions (eg, purchase of equipment or coverage of a specific drug). Although cost effectiveness does not capture all aspects of value to the system, payers, or consumers, it can be useful to assess whether investments in a new technology or drug extend life and at what added cost compared with current standard of care. In this study, we review modern breast cancer prevention, screening, and treatment cost-effectiveness analyses. We focus on breast cancer because it is a common cancer, accounts for the largest proportion of cancer economic analyses,15 has seen major advances in technology and shifts in treatment paradigms, and has cost-effectiveness analyses research spanning prevention through treatment. The results of the review are intended to determine whether new technology and therapies have improved population breast cancer outcomes at reasonable ranges of economic value, highlight gaps in the field, and inform the design of future economic analyses conducted to inform decisions about the value and prioritization of investments in breast cancer prevention and control.