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Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

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Listed:
  • Ester Vilaprinyo
  • Carles Forné
  • Misericordia Carles
  • Maria Sala
  • Roger Pla
  • Xavier Castells
  • Laia Domingo
  • Montserrat Rue
  • the Interval Cancer (INCA) Study Group

Abstract

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.

Suggested Citation

  • Ester Vilaprinyo & Carles Forné & Misericordia Carles & Maria Sala & Roger Pla & Xavier Castells & Laia Domingo & Montserrat Rue & the Interval Cancer (INCA) Study Group, 2014. "Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-10, February.
  • Handle: RePEc:plo:pone00:0086858
    DOI: 10.1371/journal.pone.0086858
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    References listed on IDEAS

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    1. Turgay Ayer & Oguzhan Alagoz & Natasha K. Stout, 2012. "OR Forum---A POMDP Approach to Personalize Mammography Screening Decisions," Operations Research, INFORMS, vol. 60(5), pages 1019-1034, October.
    2. Sandra J. Lee & Marvin Zelen, 2008. "Mortality Modeling of Early Detection Programs," Biometrics, The International Biometric Society, vol. 64(2), pages 386-395, June.
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    Cited by:

    1. Bromley, Hannah L. & Petrie, Dennis & Mann, G.Bruce & Nickson, Carolyn & Rea, Daniel & Roberts, Tracy E., 2019. "Valuing the health states associated with breast cancer screening programmes: A systematic review of economic measures," Social Science & Medicine, Elsevier, vol. 228(C), pages 142-154.
    2. Nikolai Mühlberger & Gaby Sroczynski & Artemisa Gogollari & Beate Jahn & Nora Pashayan & Ewout Steyerberg & Martin Widschwendter & Uwe Siebert, 2021. "Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1311-1344, November.

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