Modelling the future costs of breast screening.
The aim of this paper was to estimate the future breast cancer and non-breast cancer costs associated with breast screening. The Nottingham prognostic index (NPI) was used to stratify patients into different prognostic groups and to predict the impact of breast screening on future costs. A Markov model was used to estimate breast cancer and non-breast costs for each prognostic group. Breast cancer costs were found to increase as the severity of prognosis increases. The opposite pattern was found for non-breast cancer costs. The total future costs (breast cancer and non-breast cancer costs) for each prognostic group was between pound10000 and pound11000. As a percentage of the costs of screening, the savings in future breast cancer costs were 20.9%. Inclusion of non-breast cancer costs cancelled out any potential savings in future breast cancer cost resulting from a better prognosis and resulted in an increase of 5.7% in future costs. Whether to include the latter type of cost remains a methodological issue of debate in economic evaluation.
Johnston
K
K
Health Economics Research Centre, University of Oxford, Institute of Health Sciences, Headington, OX3 7LF, Oxford, UK. kathy.johnston@ihs.ox.ac.uk
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D017281:Cost of Illness; D004739:England; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index