Budget Impact Analysis of Switching to Digital Mammography in a Population-Based Breast Cancer Screening Program: A Discrete Event Simulation Model

Comas, Mercè; Arrospide, Arantzazu; Mar, Javier; Sala, María; Vilaprinyó, Ester; Hernández, Cristina; Cots, Francesc; Martínez, Juan; Castells, Xavier

doi:10.1371/journal.pone.0097459

Cited by 24 publications

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References 34 publications

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“…Some studies have described a reduction in PPV after the introduction of FFDM [ 2 , 5 ], whereas others [ 4 , 6 – 8 , 12 ], including ours, have shown an increase, especially in successive screenings. The implementation of digital technology in our population-based screening program reduced the number of adverse effects related to false-positive results and costs [ 23 ], with similar cancer detection and interval cancer rates.…”

Section: Discussionmentioning

confidence: 99%

Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization

et al. 2014

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PurposeTo provide a complete evaluation of the long-term impact of full-field digital mammography (FFDM) on the improvement of early diagnosis in a population-based screening program.MethodsWe included 82,961 screen-film mammograms (SFM) and 79,031 FFDM from women aged 50–69 screened biennially from 1995–2010 in Spain and followed-up to 2012. The first screening round of the program was excluded. Rates of cancer detection, interval cancer, tumoral characteristics and other quality indicators were compared between SFM and FFDM periods using the Chi-square test. Multivariate logistic regression models were fitted.ResultsDetection of ductal carcinoma in situ (DCIS) significantly increased with FFDM (0.05 % vs 0.09 %; p = 0.010), along with the proportion of small invasive cancers (<20 mm) (69.37 % vs 78.90 %; p = 0.040). The false-positive rate decreased with FFDM (4.79 % vs 3.38 %; p < 0.001) without differences in the cancer detection rate (0.42 % vs 0.43 %; p = 0.685) or in the interval cancer rate (0.14 % vs 0.14 %; p = 0.816). Adjusted models showed a significant increase in the detection of DCIS in the FFDM periods.ConclusionDigitalization has supposed an improvement in early diagnosis because DCIS and small invasive cancers increased without a change in detection rate. Moreover, false-positive reduction without an increase in the interval cancer rate was confirmed.Key Points• Cancer detection did not increase after 6 years of digital mammography• Ductal carcinoma in situ rates remained higher throughout the digital period• The proportion of small invasive cancers was higher with digital mammography• We observed an improvement in early diagnosis with digital mammography• False-positive rates remained lower throughout the digital period without interval cancer increase

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Section: Discussionmentioning

confidence: 99%

Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization

et al. 2014

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“…Nevertheless, it is possible to extend observed epidemiological short term data into anticipated long term results based on simulation techniques. Several models based on European data have been published [ 14 – 17 ], but very few of those were used to assess the effect of an established screening programme on a real, dynamic population using a multi-cohort model including all the observed cohorts at each time period [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation

et al. 2015

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BackgroundSince the breast cancer screening programme in the Basque Country (BCSPBC) was started in 1996, more than 400,000 women aged 50 to 69 years have been invited to participate. Based on epidemiological observations and simulation techniques it is possible to extend observed short term data into anticipated long term results. The aim of this study was to assess the effectiveness of the programme through 2011 by quantifying the outcomes in breast cancer mortality, life-years gained, false positive results, and overdiagnosis.MethodsA discrete event simulation model was constructed to reproduce the natural history of breast cancer (disease-free, pre-clinical, symptomatic, and disease-specific death) and the actual observed characteristics of the screening programme during the evaluated period in the Basque women population. Goodness-of-fit statistics were applied for model validation. The screening effects were measured as differences in benefits and harms between the screened and unscreened populations. Breast cancer mortality reduction and life-years gained were considered as screening benefits, whereas, overdiagnosis and false positive results were assessed as harms. Results for a single cohort were also obtained.ResultsThe screening programme yielded a 16 % reduction in breast cancer mortality and a 10 % increase in the incidence of breast cancer through 2011. Almost 2 % of all the women in the programme had a false positive result during the evaluation period. When a single cohort was analysed, the number of deaths decreased by 13 %, and 4 % of screen-detected cancers were overdiagnosed. Each woman with BC detected by the screening programme gained 2.5 life years due to early detection corrected by lead time.ConclusionsFifteen years after the screening programme started, this study supports an important decrease in breast cancer mortality due to the screening programme, with reasonable risk of overdiagnosis and false positive results, and sustains the continuation of the breast cancer screening programme in the Basque population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1700-4) contains supplementary material, which is available to authorized users.

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“…En coherencia con lo encontrado en la literatura 2,11,12 los dos determinantes principales del coste total del cáncer de mama son el tratamiento inicial de los estadíos I a III y el coste del estadío IV. Entre todos generan la mayor parte del coste del tratamiento del CM.…”

Section: Discussionunclassified

“…A medida que el estadío es más avanzado, el consumo de recursos crece de forma importante. Nuestros resultados son similares a los descritos en Cataluña 11,12 . Sin embargo, nuestros resultados son los únicos que desagregan los costes por estadío en función de los componentes.…”

Section: Discussionunclassified

Coste del tratamiento del cáncer de mama por estadío clínico en el País Vasco

Arrospide

Soto-Gordoa²,

Acaiturri

et al. 2015

Rev. Esp. Salud Publica

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RESUMENFundamentos: La carga económica de la asistencia sanitaria del cáncer de mama es importante. En el contexto de la evaluación del programa de cribado de cáncer de mama del País Vasco es importante conocer los costes unitarios actuales del diagnóstico y el coste de los tratamientos desagregados por el estadío clínico de detección. El objetivo de este estudio fue calcular los costes total y desagregado por componentes del tratamiento del cáncer de mama (CM) según estadío clínico en el año 2011. Métodos:Los costes sanitarios se estimaron desde el diagnóstico hasta la finalización de los tratamientos y seguimiento a partir del consumo de recursos y los costes unitarios del Sistema Vasco de Salud. La técnica aplicada fue el método de micro-costes a partir de las guías de práctica clínica.Resultados: El coste inicial fue de 9.838 € en el estadío 0, de 17.273€ en el I, de 22.145 € en el II y de 28.776 € en el III. El coste del seguimiento anual fue de 172 € en el estadío 0, de 908 € en el I, de 994 € en el II y de 1.166€ en el III. El coste anual del estadío IV fue de 17.879 €.Conclusiones: El componente de mayor coste es la quimioterapia. Los dos determinantes principales del coste total del cáncer de mama son el tratamiento inicial de los estadíos I a III y el coste del estadío IV alcanzando este último los 50.061 € por paciente.Palabras clave: Costos y análisis de costo. Neoplasias de la mama. Detección precóz del cáncer. Estadificación de neoplasias. Quimioterapia. ABSTRACT Cost of Breast Cancer Treatment by ClinicalStage in the Basque Country, SpainBackground: The burden of breast cancer is important for the healthcare system. In the context of the evaluation of the breast cancer screening program in the Basque Country it is important to determine the unitary costs related to diagnosis as well as the treatment costs depending on the clinical stage at detection. The main objective was to calculate the total cost and the components of breast cancer (BC) treatment depending on the clinical stage by 2011.

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Budget Impact Analysis of Switching to Digital Mammography in a Population-Based Breast Cancer Screening Program: A Discrete Event Simulation Model

Cited by 24 publications

References 34 publications

Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization

Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization

Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation

Coste del tratamiento del cáncer de mama por estadío clínico en el País Vasco

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