Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer.
The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.
Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain ; Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain.
Ester
E
Vilaprinyo
Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain ; Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain.
Carles
C
Forné
Economics Department and Research Centre on Industrial and Public Economics (CREIP), Rovira i Virgili University, Reus, Catalonia, Spain.
Misericordia
M
Carles
Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain ; Health Services Research Network in Chronic Diseases (REDISSEC), Spain.
Maria
M
Sala
Surgery Department, Rovira i Virgili University, Reus, Catalonia, Spain ; General and Digestive Surgery Department, Joan XXIII Teaching Hospital, Tarragona, Catalonia, Spain.
Roger
R
Pla
Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain ; Health Services Research Network in Chronic Diseases (REDISSEC), Spain.
Xavier
X
Castells
Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain.
Laia
L
Domingo
Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain ; Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain ; Health Services Research Network in Chronic Diseases (REDISSEC), Spain.
Montserrat
M
Rue
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012042:Registries / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000191:economics*; D012680:Sensitivity and Specificity; D013030:Spain