The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria

Schiller-Fruehwirth, I; Jahn, Beate; Einzinger, Patrick; Zauner, Günther; Urach, Christoph; Siebert, Uwe

doi:10.1016/j.jval.2017.04.009

Cited by 23 publications

(24 citation statements)

References 59 publications

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“…Patients identified as false positive or false negative are particularly difficult to consider in cost-effectiveness analysis given the lack of data on these patients. Costs and outcomes for patients who followed incorrect screening and treatment pathways were included in 22 (32.3%) of the studies [ 12 , 17 , 18 , 21 , 23 – 25 , 29 , 36 , 40 , 42 , 43 , 45 – 54 ]. Even though some cost-effectiveness analyses identified false positives in the screening pathways, one alternative was to assume 100% accurate diagnostic tests; this meant patients identified incorrectly during screening would never go on to inappropriate treatment [ 29 , 42 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

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Section: Resultsmentioning

confidence: 99%

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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“…Our study found that in 2016 the mammography-screening program in Kazakhstan was cost-effective with the incremental costeffectiveness ratio equaled to USD 3,157. Mammography screening has proven to be effective in several developed countries (Nyström et al, 1993;Fracheboud et al, 2003;Fruehwirth et al, 2017;Arrospide et al, 2016). However, the cost-effectiveness of mammography screening programs in post-Soviet economic transitional countries such as Kazakhstan is absent.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, Table 7 demonstrates the sensitivity analysis using 5 parameters. At the same time, based on a willingness-to-pay a threshold of triple the GDP, a total of USD 22,530 per life-year-gained in 2016, the mammography screening is cost-effective (Schiller-Fruehwirth et al, 2017). However, as the willingness-to-pay is associated with income and circumstances, the cost-effectiveness threshold based on willingness-to-pay was not utilized in this study (Wagnera et al, 2000).…”

Section: Sensitivity Analysismentioning

confidence: 98%

Cost- Effectiveness of Mammography Screening Program in a Resource-Limited Post-Soviet Country of Kazakhstan

Salikhanov

Crape

Howie

2019

Asian Pac J Cancer Prev

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the survival rates of women with breast cancer who underwent clinical examination and self-detection were 94.3%, and 84.8%, respectively (Kawai et al., 2009). It is projected that further implementation of the nationwide mammography-screening program in Kazakhstan would obtain an additional health benefits in breast cancer outcomes at a lower cost. However, currently there is absence of evidence regarding the health

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“…After age and genetic factors, such as BRCA status, a linear increase in breast density, which means that women with a Breast Imaging Reporting and Data System (BI-RADS) category of D are associated with a four- to sixfold increase in the risk of breast cancer compared to women in the lowest density group, BI-RADS A ( 36 ). Health authorities have recognized the relevance and impact of breast density in screening and, in some countries, supplemental screening methods for women with dense breasts (ACR categories C and D) have been introduced ( 37 – 39 ). In this context, it also stands to reason that breast density may be used for individual risk assessment and tailored screening strategies ( 10 , 12 , 34 , 35 ).…”

Section: Breast Densitymentioning

confidence: 99%

“…The Japan Strategic Anti-Cancer Randomized Trial (J-STAT) investigated the efficacy of additional US in a large nationwide screening program for breast cancer, with a significantly higher breast cancer detection rate, a lower number of interval cancers, and the detection of additional cancers, compared to mammography alone, in women aged 40–49 years ( 84 ). In addition, Austria started a nationwide biannual mammography screening program offering additional US for those with density categories C and D. Initial results are expected to be presented soon ( 39 ). To overcome the observer-dependency of hand-held supplemental screening US, automated, 3D, whole-breast US (ABUS) has been introduced ( 85 – 87 ).…”

Section: Supplemental Screening Modalitiesmentioning

confidence: 99%

Density and tailored breast cancer screening: practice and prediction – an overview

Wengert

Helbich

Kapetas

et al. 2018

Acta Radiologica Open

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Mammography, as the primary screening modality, has facilitated a substantial decrease in breast cancer-related mortality in the general population. However, the sensitivity of mammography for breast cancer detection is decreased in women with higher breast densities, which is an independent risk factor for breast cancer. With increasing public awareness of the implications of a high breast density, there is an increasing demand for supplemental screening in these patients. Yet, improvements in breast cancer detection with supplemental screening methods come at the expense of increased false-positives, recall rates, patient anxiety, and costs. Therefore, breast cancer screening practice must change from a general one-size-fits-all approach to a more personalized, risk-based one that is tailored to the individual woman’s risk, personal beliefs, and preferences, while accounting for cost, potential harm, and benefits.This overview will provide an overview of the available breast density assessment modalities, the current breast density screening recommendations for women at average risk of breast cancer, and supplemental methods for breast cancer screening. In addition, we will provide a look at the possibilities for a risk-adapted breast cancer screening.

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The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria

Abstract: The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria.

Cited by 23 publications

References 59 publications

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Cost- Effectiveness of Mammography Screening Program in a Resource-Limited Post-Soviet Country of Kazakhstan

Density and tailored breast cancer screening: practice and prediction – an overview

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