title: Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: a randomized controlled trial.
abstract: OBJECTIVE
  Increased recall rates in the Dutch breast cancer screening program call for a new assessment strategy aiming to reduce unnecessary costs and anxiety. Diagnostic work-up (usual care) includes multidisciplinary hospital assessment and is similar for all recalled women, regardless of the radiologist's suspicion of breast cancer. This is similar in many Canadian settings. We developed a novel assessment strategy that offers women with a low suspicion of breast cancer a quick and non-invasive assessment by a screening radiologist (intervention). We compared these two strategies in a cost-effectiveness analysis based on a randomized controlled trial: multicentre randomized controlled trial (MASS trial, Netherlands National Trial Register: NTR1480).
  
  
  METHODS
  Participants were enrolled between August 2010 and December 2012 and were randomly assigned to either the intervention or control group (allocation ratio 2:1). Fourteen assessment centres participated in the study. Questionnaires were used to record quality of life (EuroQol-5D), health care use and costs after recall.
  
  
  RESULTS
  Our study comprised 366 women, of whom 288 were randomly assigned to the intervention group and 88 to the control group. The mean difference in cost was €153/CAD $226 (95% confidence interval €107-199/CAD $158-294, p&lt;0.001). We found no significant differences in quality of life. The bootstrapped incremental cost-effectiveness ratios in the cost-effectiveness plane showed that the intervention was the efficient, cost-saving modality.
  
  
  CONCLUSIONS
  Our data show the benefits of tailoring diagnostic assessment to the screening radiologist's suspicion of breast cancer. Scenarios of implementing such a strategy in the Dutch screening or health care system are currently being discussed with various stakeholders.
authors.affiliation: Dutch National Expert and Training Centre for Breast Cancer Screening. janine.timmers@radboudumc.nl.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Timmers
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Damen
authors.forename: Ruud M
authors.initials: RM
authors.lastname: Pijnappel
authors.forename: André L
authors.initials: AL
authors.lastname: Verbeek
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: den Heeten
authors.forename: Eddy M
authors.initials: EM
authors.lastname: Adang
authors.forename: Mireille J
authors.initials: MJ
authors.lastname: Broeders
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D015397:Program Evaluation
keywords: Cost-benefit analysis; breast neoplasms; early detection of cancer