Cost-effectiveness Of Breast Cancer Screening Research Articles

Flexible transition probability model for assessing cost-effectiveness of breast cancer screening extension to include women aged 45-49 and 70-74.

Breast cancer is the most common cancer among Western women. Fortunately, organized screening has reduced breast cancer mortality. New recommendation by the European Union suggests extending screening with mammography from 50-69-year-old women to 45-74-year-old women. However, before extending screening to new age groups, it's essential to carefully consider the benefits and costs locally as circumstances vary between different regions and/or countries. We propose a new approach to assess cost-effectiveness of breast cancer screening for a long-ongoing program with incomplete historical screening data. The new model is called flexible stage distribution model. It is based on estimating the breast cancer incidence and stage distributions of breast cancer cases under different screening strategies. The model parameters, for each considered age group, include incidence rates under screening/non-screening, probability distribution among different stages, survival by stages, and treatment costs. Out of these parameters, we use the available data to estimate survival rates and treatment costs, while the modelling is done for incidence rates and stage distributions under screening policies for which the data is not available. In the model, an ongoing screening strategy may be used as a baseline and other screening strategies may be incorporated by changes in the incidence rates. The model is flexible, as it enables to apply different approaches for estimating the altered stage distributions. We apply the proposed flexible stage distribution model for assessing incremental cost of extending the current biennial breast cancer screening to younger and older target ages in Finland.

Cost-effectiveness of Breast Cancer Screening from 2013-2022: A Bibliometric Study

Cost-effectiveness of Breast Cancer Screening from 2013-2022: A Bibliometric Study

Economic potential of abbreviated breast MRI for screening women with dense breast tissue for breast cancer

ObjectivesAbbreviated breast MRI (AB-MRI) was introduced to reduce both examination and image reading times and to improve cost-effectiveness of breast cancer screening. The aim of this model-based economic study was to analyze the cost-effectiveness of full protocol breast MRI (FB-MRI) vs. AB-MRI in screening women with dense breast tissue for breast cancer.MethodsDecision analysis and a Markov model were designed to model the cumulative costs and effects of biennial screening in terms of quality-adjusted life years (QALYs) from a US healthcare system perspective. Model input parameters for a cohort of women with dense breast tissue were adopted from recent literature. The impact of varying AB-MRI costs per examination as well as specificity on the resulting cost-effectiveness was modeled within deterministic sensitivity analyses.ResultsAt an assumed cost per examination of $ 263 for AB-MRI (84% of the cost of a FB-MRI examination), the discounted cumulative costs of both MR-based strategies accounted comparably. Reducing the costs of AB-MRI below $ 259 (82% of the cost of a FB-MRI examination, respectively), the incremental cost-effectiveness ratio of FB-MRI exceeded the willingness to pay threshold and the AB-MRI-strategy should be considered preferable in terms of cost-effectiveness.ConclusionsOur preliminary findings indicate that AB-MRI may be considered cost-effective compared to FB-MRI for screening women with dense breast tissue for breast cancer, as long as the costs per examination do not exceed 82% of the cost of a FB-MRI examination.Key Points• Cost-effectiveness of abbreviated breast MRI is affected by reductions in specificity and resulting false positive findings and increased recall rates.• Abbreviated breast MRI may be cost-effective up to a cost per examination of 82% of the cost of a full protocol examination.• Abbreviated breast MRI could be an economically preferable alternative to full protocol breast MRI in screening women with dense breast tissue.

Cost-Effectiveness of Breast Cancer Screening in Shiraz, Iran.

Breast cancer is the most common cancer in the world, which accounts for 21.4% of all kinds of cancers for women in Iran. However, the treatment of breast cancer is costly and given that the budget devoted to the healthcare sector is limited, the present study aimed to investigate the cost-effectiveness of breast cancer screening for women, who referred to breast clinic located in Shahid Motahari clinic affiliated to Shiraz University of Medical Sciences, Shiraz city, Iran in 2017-2018. This study is a cross-sectional study analyzing the cost-effectiveness of breast cancer screening versus no screening. The study was conducted on 3500 women, who referred to the breast clinic in Motahari clinic, at 2017-2018 in Shiraz, Iran. The patients were identified and direct costs, which were correlated to cancer breast screening, were calculated based on the patients' records with public tariff per person. Tree age pro 2011 used to analyze cost effectiveness. Based on the results obtained, the expected cost of screening and no screening were 7556 $ppp and 7840 $ppp, respectively. Given their difference in effectiveness (16%), screening was dominant (less costly and more effective) compared to no screening. Tornado diagram showed that the results had the maximum sensitivity to the increase in screening cost. In general, according to the results obtained from the current study, the screening was more cost effective compared with no screening.

Comparison of cost-effectiveness of breast cancer screening by mammographic and ultrasonic methods in the healthcare system of the Chechen Republic

<h3></h3> Для Чеченской Республики характерен недостаточный уровень выявления злокачественных новообразований, что не позволяет точно рассчитать целевой уровень объемов прижизненной диагностики, необходимый для повышения эффективности скрининговых мероприятий в рамках диспансеризации. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Сравнить экономическую эффективность проведения скрининга рака молочной железы путем маммографии или ультразвукового исследования в качестве монометодов, а также при использовании комбинации данных методов на примере здравоохранения Чеченской Республики. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Оценка затрат проведена на основании тарифного соглашения на 2021 г. Стоимость одного выявленного случая рака молочной железы для трех вариантов применения методов рассчитана исходя из следующих составляющих: стоимость диагностического исследования, стоимость осмотра врачом-акушером-гинекологом в рамках диспансеризации; стоимость приема у врача-онколога; стоимость госпитализации в диагностических целях с проведением биопсии. <h3>РЕЗУЛЬТАТЫ</h3> В ходе исследования впервые разработана и предложена комплексная схема маршрутизации женщин в возрасте старше 40 лет при совместном использовании маммографии и ультразвукового метода исследования. Наименьшим по стоимости 1 выявленного случая рака молочной железы является применение в рамках диспансеризации маммографии в качестве монометода — от 479 тыс. руб./случай до 1,5 млн руб./случай. Наибольшим по стоимости 1 выявленного случая рака молочной железы является применение в рамках диспансеризации ультразвукового метода — от 1,2 млн руб./случай до 3,1 млн руб./случай. Применение маммографии с последующим применением ультразвукового метода характеризовалось промежуточной величиной суммарной стоимости скрининговых мероприятий и последующего оказания специализированной медицинской помощи — от 708 тыс. руб./случай до 3,1 млн руб./случай, а также наибольшим уровнем выявления — от 265 случаев в год до 506 случаев в год. <h3>ЗАКЛЮЧЕНИЕ</h3> Полученные результаты свидетельствуют о необходимости внесения изменений в территориальную программу государственных гарантий Чеченской Республики в части включения обязательного дополнительного ультразвукового исследования молочной железы для всех отрицательных случаев по результатам маммографии обеих молочных желез в рамках программы диспансеризации женского населения в возрасте старше 40 лет.

Beyond the AJR: "Cost-Effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk".

Beyond the AJR: "Cost-Effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk".

Direct medical costs of breast cancer in Jordan: cost drivers and predictors

ABSTRACT Introduction: Breast cancer is the most common cancer amongst females in Jordan. The study aimed to estimate the total direct medical cost of breast cancer from a healthcare provider’s perspective. Methods: A retrospective cohort study was done to include all Jordanian females who were diagnosed with breast cancer at two leading public providers of cancer care in Jordan, Bashir Hospital and the University of Jordan Hospital. Data were extracted from the Jordan Cancer Registry (JCR) from 2011 to 2014 including demographic, clinical, and economic data of the patient. Results: A total of 877 and 665 patients were included in the first and second year after diagnosis, respectively. Costs increased in the advanced stages; costs for stages 0, I, II, III, and IV were Jordanian dinars)JD(6,749.94 ($9,517.42), JD 5,960.46 ($8,404.25), JD 8,003.58 ($11,285.05), JD 9,390.59 ($13,240.73), and JD 9,587.44 ($13,518.29), respectively. Treatment costs were the main cost driver across all stages. Conclusions: This analysis offers insight into costs, cost drivers, and resources utilization incurred by breast cancer patients in Jordan. Two major hospitals in Jordan can play a key informative role in future cost-effectiveness of breast cancer screening and therapeutic treatments in the different stages of cancer.

Cost-effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk

For women with a 20% or more familial risk of breast cancer without a known BRCA1/2 (BRCA1, OMIM 113705; and BRCA2, OMIM 114480) or TP53 (OMIM 151623) variant, screening guidelines vary substantially, and cost-effectiveness analyses are scarce. To assess the cost-effectiveness of magnetic resonance imaging (MRI) screening strategies for women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. In this economic evaluation, conducted from February 1, 2019, to May 25, 2020, microsimulation modeling was used to estimate costs and effectiveness on a lifetime horizon from age 25 years until death of MRI screening among a cohort of 10 million Dutch women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. A Dutch screening setting was modeled. Most data were obtained from the randomized Familial MRI Screening (FaMRIsc) trial, which included Dutch women aged 30 to 55 years. A health care payer perspective was applied. Several screening protocols with varying ages and intervals including those of the randomized FaMRIsc trial, consisting of the mammography (Mx) protocol (annual mammography and clinical breast examination) and the MRI protocol (annual MRI and clinical breast examination plus biennial mammography). Costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated and discounted by 3%. A threshold of €22 000 (US $24 795.87) per QALY was applied. This economic evaluation modeling study estimated that, on a lifetime horizon per 1000 women with the Mx protocol of the FaMRIsc trial, 346 breast cancers would be detected, and 49 women were estimated to die from breast cancer, resulting in 22 885 QALYs and total costs of €7 084 767 (US $7 985 134.61). The MRI protocol resulted in 79 additional QALYs and additional €2 657 266 (US $2 994 964.65). Magnetic resonance imaging performed only every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of €21 380 (US $24 097.08) compared with the previous nondominated strategy in the ranking, when applying the National Institute for Health and Care Excellence threshold. Annual screening alternating MRI and mammography between the ages of 35 and 60 years, followed by the national screening program, gave similar outcomes. Higher thresholds would favor annual MRI screening. The ICER was most sensitive to the unit cost of MRI and the utility value for ductal carcinoma in situ and localized breast cancer. This study suggests that MRI screening every 18 months between the ages of 35 and 60 years for women with a family history of breast cancer is cost-effective within the National Institute for Health and Care Excellence threshold for all densities. Higher thresholds would favor annual MRI screening. These outcomes support a change of current screening guidelines for this specific risk group and support MRI screening.

Cost-Effectiveness of National Breast Cancer Screening Programs in Developing Countries, with Reference to the Recent Egyptian Initiative

Breast cancer was the second most common cancer in the world and the most common cancer in women both in developed and less developed world. It ranked the fifth cause of death from all cancers and caused the greatest number of cancer related deaths among women in 2018. A variety of factors have been shown to impact an individual’s risk of developing breast cancer and its ultimate prognosis. Screening for breast cancer will help to reduce mortality, to confer lifetime protection, and to protect those with high risk factors. Cost-effectiveness analysis refers to the economic evaluation in which the costs and consequences of alternative interventions are expressed in cost per unit of health outcome. Studies on cost-effectiveness of screening programs in developing countries used different methods and calculated different outcome measures. They studied different tools used for screening. Some studied the cost-effectiveness of clinical breast examination and others studied that of mammography. The outcome measures varied, some studies calculated the cost-effectiveness ratio, while others calculated the incremental cost-effectiveness ratio, the disability adjusted life years and the quality adjusted life years. It is concluded that although population-based mammography has been widely adopted in high-income countries, it is less cost–effective in low- and middle-income countries which face some challenges such as the problem of investment in screenings. In developing countries, further research to study the cost-effectiveness of breast cancer screening, covering a comprehensive set of interventions and resulting in clear policy recommendations, is required.

Systematic reviews as a "lens of evidence": Determinants of cost-effectiveness of breast cancer screening.

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.

Long-Term Outcomes and Cost-Effectiveness of Breast Cancer Screening With Digital Breast Tomosynthesis in the United States.

Digital breast tomosynthesis (DBT) is increasingly being used for routine breast cancer screening. We projected the long-term impact and cost-effectiveness of DBT compared to conventional digital mammography (DM) for breast cancer screening in the United States. Three Cancer Intervention and Surveillance Modeling Network breast cancer models simulated US women ages 40 years and older undergoing breast cancer screening with either DBT or DM starting in 2011 and continuing for the lifetime of the cohort. Screening performance estimates were based on observational data; in an alternative scenario, we assumed 4% higher sensitivity for DBT. Analyses used federal payer perspective; costs and utilities were discounted at 3% annually. Outcomes included breast cancer deaths, quality-adjusted life-years (QALYs), false-positive examinations, costs, and incremental cost-effectiveness ratios (ICERs). Compared to DM, DBT screening resulted in a slight reduction in breast cancer deaths (range across models 0-0.21 per 1000 women), small increase in QALYs (1.97-3.27 per 1000 women), and a 24-28% reduction in false-positive exams (237-268 per 1000 women) relative to DM. ICERs ranged from $195026 to $270135 per QALY for DBT relative to DM. When assuming 4% higher DBT sensitivity, ICERs decreased to $130533-$156624 per QALY. ICERs were sensitive to DBT costs, decreasing to $78731 to $168883 and $52918 to $118048 when the additional cost of DBT was reduced to $36 and $26 (from baseline of $56), respectively. DBT reduces false-positive exams while achieving similar or slightly improved health benefits. At current reimbursement rates, the additional costs of DBT screening are likely high relative to the benefits gained; however, DBT could be cost-effective at lower screening costs.

Clinical outcomes and cost-effectiveness of breast cancer screening for childhood cancer survivors treated with chest radiation: A comparative modeling study.

6525 Background: Survivors of childhood cancer previously treated with chest radiation face elevated breast cancer risk similar to BRCA1 carriers. Children’s Oncology Group (COG) guidelines recommend annual mammography with breast MRI, yet the benefits and costs of various screening strategies are uncertain. Methods: We used two breast cancer simulation models (Model 1 and 2) from the Cancer Intervention and Surveillance Modeling Network (CISNET) and data from the Childhood Cancer Survivor Study to reflect high breast cancer and competing mortality risks among survivors. We simulated 3 screening strategies: annual mammography with MRI starting at age 25 (COG25), annual MRI starting at 25 (MRI25), and biennial mammography starting at 50 (Mammo50). Performance of mammography+/-MRI was based on published studies in BRCA1/2 carriers who have similar cancer risk. Costs and quality of life weights were based on US averages and published studies. Results: Among a simulated cohort of 25-year-old survivors treated with chest radiation, the lifetime breast cancer mortality risk in the absence of screening was 10-11% across models. Compared to no screening, Mammo50, MRI25, and COG25 screening avert approximately 23-25%, 56-62% and 56-71% of deaths, respectively; averted deaths for COG25 compared to MRI25 were higher in Model 1 than Model 2 (9% vs. &lt;1%). In Model 1, both MRI25 and COG25 were cost-effective; in Model 2, MRI25 was preferable (more effective, less costly than COG25). Conclusions: Compared to no screening, initiating annual screening at younger ages for at-risk survivors averts &gt;50% of breast cancer deaths and is cost-effective. Additional data on test performance are needed to inform recommendations on screening modality. [Table: see text]

Cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program.

To estimate the cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Using a modified CISNET breast cancer simulation model, we estimated outcomes for women aged 40-64years associated with three scenarios: breast cancer screening within the NBCCEDP, screening in the absence of the NBCCEDP (no program), and no screening through any program. We report screening outcomes, cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and sensitivity analyses results. Compared with no program and no screening, the NBCCEDP lowers breast cancer mortality and improves QALYs, but raises health care costs. Base-case ICER for the program was $51,754/QALY versus no program and $50,223/QALY versus no screening. Probabilistic sensitivity analysis ICER for the program was $56,615/QALY [95% CI $24,069, $134,230/QALY] versus no program and $51,096/QALY gained [95% CI $26,423, $97,315/QALY] versus no screening. On average, breast cancer screening in the NBCCEDP was cost-effective compared with no program or no screening.

Breast cancer screening programme in China: does one size fit all? A cost-effectiveness analysis based on a Markov model

BackgroundIn China, breast cancer is the most frequently diagnosed cancer in women. Marked disparities between urban and rural populations have been reported for breast cancer incidence and survival. In 2009, China launched a breast cancer screening programme for women living in rural areas who were aged 35–64 years and at average risk. The programme used ultrasound combined with clinical breast examination as the primary screening tool. In 2012, breast cancer screening was done by use of ultrasound, and was followed by mammography among women living in urban areas aged 40–69 years, who were high risk and were identified through risk assessment questionnaires. To date, economic evidence is still scarce. This study aimed to analyse the cost-effectiveness of breast cancer screening compared with no screening among women in rural and urban China. MethodsWe developed a Markov model to estimate the lifetime costs and effects, from a societal perspective, for the general population-based cohorts, both in urban China with high incidence of breast cancer and rural China with low incidence of breast cancer. Analyses were done for women in rural areas aged 35 years and women in urban areas aged 40 years. Women who were asymptomatic in the intervention arm were screened every 3 years. Breast cancer in the non-screening arm could only be diagnosed on presentation of symptoms. The main outcome measure was cost per quality-adjusted life-year (QALY) gained with a 3% annual discount. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. FindingsCompared with no screening, the rural breast cancer screening programme cost US$186·72 more and led to a loss of 0·20 QALYs because of disutility from false positives. Breast cancer screening among women in rural China is more expensive, with an incremental cost-effectiveness ratio (ICER) of $-916 per QALY, compared with no screening. In urban areas, the breast cancer screening programme cost $84·99 and gained 0·01 QALYs, with an ICER of $6671 per QALY, well below the willingness-to-pay threshold of $23 050 per QALY at three times GDP per capita (2014) in China. The results are shown to be robust through the sensitivity analyses. InterpretationIn a rural setting, which has low breast cancer incidence, screening for asymptomatic disease among the general population using current screening tools is not cost-effective. Priority should be given to ensure that women who are symptomatic have access to diagnosis and treatment at an early stage. In urban China, a high-risk population-based screening method for breast cancer is very likely to be cost-effective compared with no screening. FundingNational Natural Science Foundation of China (71273016 and 71673004).

PMD25 - Cost Effectiveness of Breast Cancer Screening for Women in Rural China

In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women with ultrasound and clinical breast examination as the primary screening tool. This study aimed to analyse the cost-effectiveness of breast cancer screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every three years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186·72 more and led to a loss of 0·20 quality-adjusted life years (QALYs). Breast cancer screening was more expensive and did harm to health among Chinese rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified disutility from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Instead, priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to reductions in mortality from the disease without the usual harms associated with screening.

Cost-effectiveness of breast cancer screening using mammography in Vietnamese women.

BackgroundThe incidence rate of breast cancer is increasing and has become the most common cancer in Vietnamese women while the survival rate is lower than that of developed countries. Early detection to improve breast cancer survival as well as reducing risk factors remains the cornerstone of breast cancer control according to the World Health Organization (WHO). This study aims to evaluate the costs and outcomes of introducing a mammography screening program for Vietnamese women aged 45–64 years, compared to the current situation of no screening.MethodsDecision analytical modeling using Markov chain analysis was used to estimate costs and health outcomes over a lifetime horizon. Model inputs were derived from published literature and the results were reported as incremental cost-effectiveness ratios (ICERs) and/or incremental net monetary benefits (INMBs). One-way sensitivity analyses and probabilistic sensitivity analyses were performed to assess parameter uncertainty.ResultsThe ICER per life year gained of the first round of mammography screening was US$3647.06 and US$4405.44 for women aged 50–54 years and 55–59 years, respectively. In probabilistic sensitivity analyses, mammography screening in the 50–54 age group and the 55–59 age group were cost-effective in 100% of cases at a threshold of three times the Vietnamese Gross Domestic Product (GDP) i.e., US$6332.70. However, less than 50% of the cases in the 60–64 age group and 0% of the cases in the 45–49 age group were cost effective at the WHO threshold. The ICERs were sensitive to the discount rate, mammography sensitivity, and transition probability from remission to distant recurrence in stage II for all age groups.ConclusionFrom the healthcare payer viewpoint, offering the first round of mammography screening to Vietnamese women aged 50–59 years should be considered, with the given threshold of three times the Vietnamese GDP per capita.

Quality assurance target for community-based breast cancer screening in China: a model simulation

BackgroundWe aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control.MethodsA state-transition Markov model simulated a hypothetical cohort of 100,000 healthy women, the start aged was set at 35 years and the time horizon was set to 50 years. The primary outcome for the model was the incremental cost-utility ratio (ICUR), defined as the program’s cost per quality-adjusted life year (QALY) gained. Three screening strategies providing by community health service for women aged 35 to 69 years was compared regarding to different intervals.ResultThe probability of the ICUR being below 20 272USD (i.e., triple the annual gross domestic product [3 GDPs]) per QALY saved was 100% for annual screening strategy and screening every three years. Only when the attendance rate was > 50%, the probability for annual screening would be cost effective > 95%. The probability for the annual screening strategy being cost effective could reach to 95% for a willingness-to-pay (WTP) of 2 GDPs when the compliance rate for transfer was > 80%. When 10% stage I tumors were detected by screening, the probability of the annual screening strategy being cost effective would be up to 95% for a WTP > 3 GDPs.ConclusionAnnual community-based breast cancer screening was cost effective for a WTP of 3 GDP based on the incidence of breast cancer in Tianjin, China. Measures are needed to ensure performance indicators to a desirable level for the cost-effectiveness of breast cancer screening.

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project.

We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.

What determines the effects and costs of breast cancer screening? A protocol of a systematic review of reviews

BackgroundMultiple reviews demonstrated high variability in effectiveness and cost-effectiveness outcomes among studies on breast cancer screening (BCS) programmes. No study to our knowledge has summarized the current evidence on determinants of effectiveness and cost-effectiveness of the most used BCS approaches or tried to explain differences in conclusions of systematic reviews on this topic. Based on published reviews, this systematic review aims to assess the degree of variability of determinants for (a) effectiveness and (b) cost-effectiveness of BCS programmes using mammography, clinical breast examination, breast self-examination, ultrasonography, or their combinations among the general population.MethodsWe will perform a comprehensive systematic literature search in Cochrane, Scopus, Embase, and Medline (via Pubmed). The search will be supplemented with hand searching of references of the included reviews, with hand searching in the specialized journals, and by contacting prominent experts in the field. Additional search for grey literature will be conducted on the websites of international cancer associations and networks. Two trained research assistants will screen titles and abstracts of publications independently, with at least random 10% of all abstracts being also screened by the principal researcher. The full texts of the systematic reviews will then be screened independently by two authors, and disagreements will be solved by consensus. The included reviews will be grouped by publication year, outcomes, designs of original studies, and quality. Additionally, for reviews published since 2011, transparency in reporting will be assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for the review on determinants of effectiveness and a modified PRISMA checklist for the review on determinants for cost-effectiveness. The study will apply the Assessing the Methodological Quality of Systematic Reviews checklist to assess the methodological quality of systematic reviews. We will report the data extracted from the systematic reviews in a systematic format. Meta-meta-analysis of extracted data will be conducted when feasible.DiscussionThis systematic review of reviews will examine the degree of variability in the effectiveness and cost-effectiveness of BCS programmes.Systematic review registrationPROSPERO CRD42016050764 and CRD42016050765

Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?

IntroductionOne key tool thought to combat the spiraling costs of late-stage breast cancer diagnosis is the use of breast cancer screening. However, over recent years, more effective treatments and questions being raised over the safety implications of using mammography have led to the cost-effectiveness of breast cancer screening to be highlighted as an important issue to investigate.MethodsA cost–utility analysis was conducted to appraise the breast cancer screening program. The analysis considered the breast cancer screening program and its utility over a 20-year period, accounting for the typical breast cancer screening period taking place between the ages of 50 and 70 years. Analysis was conducted from the perspective of the UK National Health Service (NHS). This accepted NHS threshold was utilized for analysis of £20,000/quality-adjusted life year (QALY)–£30,000/QALY gain. A systematic literature review was conducted to obtain relevant financial, health, and probability outcomes pertaining to the breast cancer screening program.ResultsThe mean incremental cost-effectiveness ratio (ICER) calculated was at a value of £11,546.11 with subsequent sensitivity analysis conducted around this value. Three sensitivity analyses were undertaken to evaluate ICERs of a range of scenarios which could occur as the following: 1) maximum costs at each node – £17,254/QALY; 2) all costs are fixed costs: screening center costs, and staff are paid for regardless of use – £14,172/QALY; and 3) combination of (1) and (2) to produce a worst case scenario £20,823/QALY.Discussion and conclusionThe majority of calculations suggested that breast cancer screening is cost-effective. However, in our worst case scenario, the ICER fell near the bottom ceiling ratio. This makes it unclear whether the program should be available in the future, as more evidence becomes available over the risks of screening and as some currently expensive chemotherapy drugs begin to lose patents.