Abstract
Systematic reviews with economic components are important decision tools for stakeholders seeking to evaluate technologies, such as breast cancer screening (BCS) programs. This overview of systematic reviews explores the determinants of the cost‐effectiveness of BCS and assesses the quality of secondary evidence. The search identified 30 systematic reviews that reported on the determinants of the cost‐effectiveness of BCS, including the costs of breast cancer and BCS. While the quality of the reviews varied widely, only four out of 30 papers were considered to be of a high quality. We did not identify publication bias in the original evidence on the cost‐effectiveness of mammography screening; however, we highlight a need for improved clarity in both reporting and data verification. The reviews consisted mainly of studies from high‐income countries. Breast cancer costs varied widely among the studies. Factors leading to higher costs included: time (diagnosis and last months before death), later stage or metastases, recurrence of the disease, age below 64 years and type of follow‐up (more intensive or more specialized). Overall, screening with mammography was considered cost‐effective in the age range 50‐69 years in Western European and Northern American countries but not for older or younger women. Its cost‐effectiveness was questionable for low‐income settings and Asia. Mammography screening was more cost‐effective with biennial screening compared to annual screening and single reading using computer‐aided detection vs double reading. No information on the cost‐effectiveness of ultrasonography was found, and there is much uncertainty on the cost‐effectiveness of CBE because of methodological limitations.
Highlights
Systematic reviews are widely accepted as a tool to increase the flow of scientific information.[1]
Out of 30 included reviews, 14 reported data on the costs of breast cancer and 16 on the costs of breast cancer screening (BCS)
These reviews related to the cost‐effectiveness of BCS in Brazil, India, Mexico, Turkey, Ghana, and Egypt and productivity loss in Brazil, Peru, and Pakistan
Summary
Systematic reviews are widely accepted as a tool to increase the flow of scientific information.[1] A dramatic increase in primary health economic studies has led to a consequent proliferation of systematic reviews synthesizing this economic evidence These reviews may serve as a decision tool for stakeholders by evaluating the methodological rigor of the available economic evidence, defining principal cost drivers, summarizing variability in economic outcomes, or identifying the scientific gaps requiring further exploration. Guidelines from international cancer networks—including the European Union Council Recommendation on Cancer Screening—recommend mammography screening for this segment of the population.[4,5,6] Scarce capacity limits application of these recommendations in low‐income settings, where clinical breast examination (CBE), breast self‐examination (BSE), and screening ultrasonography may be recommended by local guidelines either as individual or supplementary interventions.[7,8,9,10,11,12,13,14,15]
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