title: Cost-effectiveness of breast cancer screening policies using simulation.
abstract: In this paper, we study breast cancer screening policies using computer simulation. We developed a multi-state Markov model for breast cancer progression, considering both the screening and treatment stages of breast cancer. The parameters of our model were estimated through data from the Canadian National Breast Cancer Screening Study as well as data in the relevant literature. Using computer simulation, we evaluated various screening policies to study the impact of mammography screening for age-based subpopulations in Canada. We also performed sensitivity analysis to examine the impact of certain parameters on number of deaths and total costs. The analysis comparing screening policies reveals that a policy in which women belonging to the 40-49 age group are not screened, whereas those belonging to the 50-59 and 60-69 age groups are screened once every 5 years, outperforms others with respect to cost per life saved. Our analysis also indicates that increasing the screening frequencies for the 50-59 and 60-69 age groups decrease mortality, and that the average number of deaths generally decreases with an increase in screening frequency. We found that screening annually for all age groups is associated with the highest costs per life saved. Our analysis thus reveals that cost per life saved increases with an increase in screening frequency.
authors: Department of Industrial Engineering, Istanbul Kemerburgaz University, İstanbul Kemerburgaz Universitesi Muhendislik ve Mimarlik Fakultesi, Mahmutbey Yerleskesi Dilmenler Cad. No: 26, 34217 Istanbul, Turkey. Electronic address: yasin.gocgun@kemerburgaz.edu.tr.
authors: Y
authors: Y
authors: Gocgun
authors: Centre for Maintenance Optimization and Reliability Engineering, University of Toronto, 40 St. George Street, Toronto, ON M5S 3G8, Canada.
authors: D
authors: D
authors: Banjevic
authors: Department of Mechanical and Industrial Engineering, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada.
authors: S
authors: S
authors: Taghipour
authors: Centre for Maintenance Optimization and Reliability Engineering, University of Toronto, 40 St. George Street, Toronto, ON M5S 3G8, Canada.
authors: N
authors: N
authors: Montgomery
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors: B J
authors: BJ
authors: Harvey
authors: Centre for Maintenance Optimization and Reliability Engineering, University of Toronto, 40 St. George Street, Toronto, ON M5S 3G8, Canada.
authors: A K S
authors: AK
authors: Jardine
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors: A B
authors: AB
authors: Miller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D002170:Canada; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000191:economics* / Q000401:mortality; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000401:mortality; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D008962:Models, Theoretical; D013997:Time Factors
keywords: Breast cancer screening; Computer simulation; Markov models