The Cost-effectiveness of Mammographic Screening Strategies

Lindfors, Karen K.; Rosenquist, C. J.

doi:10.1001/jama.1995.03530110043033

Cited by 103 publications

(23 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although BNP has only moderate sensitivity and specificity compared to echocardiography for identifying LV dysfunction (9), we found that for every 125 men screened, one year of life would be gained at a cost of $23,500. This is comparable to the estimated $16,000 cost per life year gained with annual mammography for women age 50 to 79 years (27).…”

Section: Discussionmentioning

confidence: 55%

Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction

Heidenreich

Gubens

Fonarow

et al. 2004

Journal of the American College of Cardiology

171

115

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 55%

Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction

Heidenreich

Gubens

Fonarow

et al. 2004

Journal of the American College of Cardiology

171

115

View full text Add to dashboard Cite

show abstract

“…The analyses were based in a number of countries including the USA (n = 18 239,257,263,267,271,272,274,275,277,278,283,[289][290][291][292][293]295,298 ), the UK (n = 15 241,243,246,247,249,253,261,265,273,276,279,287,297,299,303 ), the Netherlands (n = 4 242,244,256,259 ), Hong Kong (n = 4 [304][305][306][307] ), Australia (n = 3 254,262,302 ), Italy (n = 3 245,251,252 ), Japan (n = 2 284,…”

Section: Study Overviewmentioning

confidence: 99%

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Evans

Astley

Stavrinos³

et al. 2016

Programme Grants Appl Res

117

126

View full text Add to dashboard Cite

BackgroundIn the UK, women are invited for 3-yearly mammography screening, through the NHS Breast Screening Programme (NHSBSP), from the ages of 47–50 years to the ages of 69–73 years. Women with family histories of breast cancer can, from the age of 40 years, obtain enhanced surveillance and, in exceptionally high-risk cases, magnetic resonance imaging. However, no NHSBSP risk assessment is undertaken. Risk prediction models are able to categorise women by risk using known risk factors, although accurate individual risk prediction remains elusive. The identification of mammographic breast density (MD) and common genetic risk variants [single nucleotide polymorphisms (SNPs)] has presaged the improved precision of risk models.ObjectivesTo (1) identify the best performing model to assess breast cancer risk in family history clinic (FHC) and population settings; (2) use information from MD/SNPs to improve risk prediction; (3) assess the acceptability and feasibility of offering risk assessment in the NHSBSP; and (4) identify the incremental costs and benefits of risk stratified screening in a preliminary cost-effectiveness analysis.DesignTwo cohort studies assessing breast cancer incidence.SettingHigh-risk FHC and the NHSBSP Greater Manchester, UK.ParticipantsA total of 10,000 women aged 20–79 years [Family History Risk Study (FH-Risk); UK Clinical Research Network identification number (UKCRN-ID) 8611] and 53,000 women from the NHSBSP [aged 46–73 years; Predicting the Risk of Cancer At Screening (PROCAS) study; UKCRN-ID 8080].InterventionsQuestionnaires collected standard risk information, and mammograms were assessed for breast density by a number of techniques. All FH-Risk and 10,000 PROCAS participants participated in deoxyribonucleic acid (DNA) studies. The risk prediction models Manual method, Tyrer–Cuzick (TC), BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) and Gail were used to assess risk, with modelling based on MD and SNPs. A preliminary model-based cost-effectiveness analysis of risk stratified screening was conducted.Main outcome measuresBreast cancer incidence.Data sourcesThe NHSBSP; cancer registration.ResultsA total of 446 women developed incident breast cancers in FH-Risk in 97,958 years of follow-up. All risk models accurately stratified women into risk categories. TC had better risk precision than Gail, and BOADICEA accurately predicted risk in the 6268 single probands. The Manual model was also accurate in the whole cohort. In PROCAS, TC had better risk precision than Gail [area under the curve (AUC) 0.58 vs. 0.54], identifying 547 prospective breast cancers. The addition of SNPs in the FH-Risk case–control study improved risk precision but was not useful inBRCA1(breast cancer 1 gene) families. Risk modelling of SNPs in PROCAS showed an incremental improvement from using SNP18 used in PROCAS to SNP67. MD measured by visual assessment score provided better risk stratification than automatic measures, despite wide intra- and inter-reader variability. Using a MD-adjusted TC model in PROCAS improved risk stratification (AUC = 0.6) and identified significantly higher rates (4.7 per 10,000 vs. 1.3 per 10,000;p < 0.001) of high-stage cancers in women with above-average breast cancer risks. It is not possible to provide estimates of the incremental costs and benefits of risk stratified screening because of lack of data inputs for key parameters in the model-based cost-effectiveness analysis.ConclusionsRisk precision can be improved by using DNA and MD, and can potentially be used to stratify NHSBSP screening. It may also identify those at greater risk of high-stage cancers for enhanced screening. The cost-effectiveness of risk stratified screening is currently associated with extensive uncertainty. Additional research is needed to identify data needed for key inputs into model-based cost-effectiveness analyses to identify the impact on health-care resource use and patient benefits.Future workA pilot of real-time NHSBSP risk prediction to identify women for chemoprevention and enhanced screening is required.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. The DNA saliva collection for SNP analysis for PROCAS was funded by the Genesis Breast Cancer Prevention Appeal.

show abstract

“…11 Even without considering the lives saved, there is obviously a difference in quality of life and productivity for those identified to have curable disease, in contrast to patients with invasive and metastatic large bowel cancer 12. However, in less affluent countries there is a need to address different priorities such as child and maternal welfare, upgrading of medical facilities for the prevention, diagnosis, and treatment of common, but life threatening conditions such as alcoholism, lung cancer, as well as symptomatic colorectal cancer.…”

Section: (4) Can We Afford To Implement Early Detection Colorectal Screening Programs?mentioning

confidence: 99%

Colorectal cancer: does early detection matter?

Rozen

2001

Postgraduate Medical Journal

View full text Add to dashboard Cite

The Cost-effectiveness of Mammographic Screening Strategies

Cited by 103 publications

References 29 publications

Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction

Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Colorectal cancer: does early detection matter?

Contact Info

Product

Resources

About