Screening for breast cancer with Breast-CT in a ProHTA simulation

Ruile, Georg; Djanatliev, Anatoli; Kriza, Christine; Meier, Florian; Leb, Ines; Kalender, Willi A.; Kolominsky-Rabas, Peter

doi:10.2217/cer.15.42

Cited by 7 publications

(1 citation statement)

References 53 publications

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“…▶ Table 4 Overview of the number of HTA reports in radiology in the period 2012 -2017, source [23], pg. 594 publication year organ system imaging modality source 2017 breast Mammo, MRI [24] head/neck PET-CT [10] 2016 lung CT [25] lung CT, DCE-CT, FDG-PET-CT [26] all PET-CT, PET-MRI [27] 2015 breast CT [28] abdomen CTC [29] 2014 neuro MR-DWI, CT [30] all MRI [31] 2013 abdomen TE [32] abdomen Sono, CT, MRI [33] 2012 cardio CT-angio, angio [34] CTC -CT-colonography; TEtransient elastography; DCE-CTdynamic contrast-enhanced CT; FDG-PET-CT -18-fluorodeoxyglucose-positron emission tomography; MR-DWImagnetic resonance diffusion-weighted brain imaging; PETpositron emission tomography.…”

Section: Htas: Lack Of Demand Lack Of Supplymentioning

confidence: 99%

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Winkelmann

Neumann

Zeidler

et al. 2019

Fortschr Röntgenstr

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Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. Method This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation” for inpatients and “authorization right” for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies. Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector. Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures. Key Points: Citation Format

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Section: Htas: Lack Of Demand Lack Of Supplymentioning

confidence: 99%

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Winkelmann

Neumann

Zeidler

et al. 2019

Fortschr Röntgenstr

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Dedicated breast CT: state of the art—Part II. Clinical application and future outlook

Zhu

O’Connell

et al. 2021

Eur Radiol

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Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies

Mühlberger¹,

Sroczynski²,

Gogollari³

et al. 2021

Eur J Health Econ

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Objectives Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. Methods Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable costeffectiveness ratios. Results Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. Conclusions Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European modelsrisk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening. Keywords breast cancer screening; breast cancer prevention; cost effectiveness; decision analysis; risk stratification; overdiagnosisDutch MISCAN model. State-transition models were used by six studies [63,46,57,39,65,61] and mathematical models (e.g., equation-or regression-based models) were used in five studies [35,51,62,58,55]. The remaining studies used other types of models, including two decision trees [53,54], two life-table models [40,41],and two mixed models combining different model types [45,38].Thirteen models can be classified as population models considering the actual age 9 structure of the local target population. All but five models considered a lifetime-time horizon, appropriate to account for the long-term consequences of screening. More than half of the screening studies (18/32) and two thirds (14/21) of the screening studies, including strategies comparable to currently established breast cancer screening programs, performed a cost-utility analysis, which is the type of analysis required to account for all kinds of non-fatal health consequences, including most harms caused by overdiagnosis-and overtreatment. Sixteen studies, including 12 with...

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Screening for breast cancer with Breast-CT in a ProHTA simulation

Abstract: The simulation indicates that earlier cancer detection, fewer unnecessary biopsies and less pain are potential benefits of Breast-CT resulting in cost savings and higher attendance.

Cited by 7 publications

References 53 publications

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Dedicated breast CT: state of the art—Part II. Clinical application and future outlook

Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies

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