Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland

Gelder, Rianne de; Bulliard, Jean‐Luc; Wolf, Chris de; Fracheboud, Jacques; Draisma, Gerrit; Schopper, Doris; Koning, Harry J. de

doi:10.1016/j.ejca.2008.09.015

Cited by 73 publications

(66 citation statements)

References 45 publications

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“…1). 24 Screening leads to the detection of smaller tumours, which may improve survival after diagnosis. Women with a screen-or clinically detected cancer may receive adjuvant treatment, which also improves survival.…”

Section: Model Overviewmentioning

confidence: 99%

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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In the Netherlands, routine mammography screening starts at age 50. This starting age may have to be reconsidered because of the increasing breast cancer incidence among women aged 40 to 49 and the recent implementation of digital mammography. We assessed the cost-effectiveness of digital mammography screening that starts between age 40 and 49, using a microsimulation model. Women were screened before age 50, in addition to the current programme (biennial 50-74). Screening strategies varied in starting age (between 40 and 50) and frequency (annual or biennial). The numbers of breast cancers diagnosed, life-years gained (LYG) and breast cancer deaths averted were predicted and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Biennial screening from age 50 to 74 (current strategy) was estimated to gain 157 life years per 1,000 women with lifelong follow-up, compared to a situation without screening, and cost e3,376/ LYG (3.5% discounted). Additional screening increased the number of LYG, compared to no screening, ranging from 168 to 242. The costs to generate one additional LYG (i.e., ICER), comparing a screening strategy to the less intensive alternative, were estimated at e5,329 (biennial 48-74 vs. current strategy), e7,628 (biennial 45-74 vs. biennial 48-74), e10,826 (biennial 40-74 vs. biennial 45-74) and e18,759 (annual 40-49 1 biennial 50-74 vs. biennial 40-74). Other strategies (49 1 biennial 50-74 and annual 45-49 1 biennial 50-74) resulted in less favourable ICERs. These findings show that extending the Dutch screening programme by screening between age 40 and 49 is cost-effective, particularly for biennial strategies.Breast cancer is the most commonly diagnosed form of cancer among women aged 30 and older in the Netherlands. 1 Mammography screening allows for early detection and early treatment of breast cancer, with the aim of averting breast cancer death. In the Netherlands, women aged 50 to 74 are invited biennially to screening. Various randomised controlled trials demonstrated a statistically significant breast cancer mortality reduction due to mammography screening in this age group. 2-4 Furthermore, Otto et al. 5,6 showed that the Dutch population-based screening programme is effective in reducing breast cancer mortality. The evidence for the benefit of mammography screening for younger women is less conclusive, 7-9 however, an effect for this age group is supported by several studies. Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials. [10][11][12][13] In addition, a recent Swedish observational study that compared breast cancer mortality rates between women aged 40 and 49 who were invited to screening and women who were not invited to screening demonstrated a 26% statistically significant br...

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Section: Model Overviewmentioning

confidence: 99%

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Sankatsing

Heijnsdijk

Luijt

et al. 2015

Intl Journal of Cancer

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“…A study by de Gelder et al . [24] of the Swiss population-based breast cancer screening programme found a cost effectiveness ratio of 11,500 Euro per YLS and a retrospective study of the American programme estimated the costs to be 24,700 Euro per QALY gained [25]. In China, an estimate of CE- and CU-ratios of ~ 58,900 Euro per YLS and 56,400 Euro per QALY gained were concluded [26].…”

Section: Discussionmentioning

confidence: 99%

Societal costs and effects of implementing population-based mammography screening in Greenland

Niclasen

Iburg

2017

International Journal of Circumpolar Health

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With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper is to evaluate the cost effectiveness and cost utility of different strategies for implementing population-based breast cancer screening in Greenland. Two strategies were evaluated: Centralised screening in the capital Nuuk and decentralised screening in the five municipal regions of Greenland. A cost effectiveness and cost utility analysis were performed from a societal perspective to estimate the costs per years of life saved and per QALY gained. Two accommodation models for the women’s attendance were examined; accommodation in ordinary hotels or in patient hotels. The least costly accommodation model was the hotel model compared with the patient hotel model, regardless of screening strategy. The decentralised strategy was more cost effective compared with the centralised strategy, resulting in 0.5 million DKK per years of life saved (YLS) and 4.1 million DKK per quality-adjusted life year (QALY) gained within the hotel model. These ratios are significantly higher compared with findings from other countries. The sensitivity analysis showed a substantial gap between the most and least favourable model assumptions. The investigated strategies were all estimated to be extremely costly, mostly due to high transportation and accommodation costs and loss of productivity, and none would be accepted as cost-effective per YLS/QALY gained within a conventional threshold level. The least expensive strategy was regional screening with hotel accommodation.

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“…[288][289][290] A number of studies have modelled the cost-effectiveness of mammography, with early studies typically reporting life-years saved. [291][292][293][294][295][296][297][298][299][300][301][302][303] Data from these studies are shown in Table 26. The Forrest report, 296 which examined the feasibility of a national screening service in the UK, used a very simple estimate of life-years saved and considered only the costs of screening and additional biopsies.…”

Section: 117mentioning

confidence: 99%

An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.

Carr

Lhussier²,

Forster³

et al. 2011

Health Technol Assess

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Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland

Cited by 73 publications

References 45 publications

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

Societal costs and effects of implementing population-based mammography screening in Greenland

An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.

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