The cost-effectiveness of mammography-based female breast cancer screening in Canadian populations: a systematic review

AbstractIntroductionMammography-based breast cancer screening is an important aspect of female breast cancer prevention within the Canadian healthcare system. The current literature on female breast cancer screening is largely focused on the health outcomes that result from screening. There is comparatively little data on the cost-effectiveness of the screening. Therefore, this paper sought to conduct a systematic review of the literature on the cost effectiveness of mammography-based breast cancer screening within female Canadian populations.Materials and methodsA systematic review was performed in the PubMed database to identify all studies published within the last 10 years that addressed breast cancer screening and evaluate cost-effectiveness in a Canadian population.ResultsThe search yielded five studies for inclusion, only three of which were applicable to average-risk Canadian women. The benefits of mortality reduction rose approximately linearly with costs, while costs were linearly dependent on the number of lifetime screens per woman. Moreover, triennial screening for average-risk women aged 50-69 years was found to be the most cost-effective in terms of cost per quality adjusted life year. The use of MRI in conjunction with mammography for women with the BRCA 1/2 mutation was found to be cost-effective while annual mammography-based screening for women with dense breasts was found to be cost-ineffective.ConclusionIn spite of the growing interest to enhance breast cancer screening programs, analyses of the cost-effectiveness of mammography-based screening within Canadian populations are scarcely reported and have heterogeneous methodologies. The existing data suggests that Canada’s current breast cancer screening policy to screen average-risk women aged 50-74, biennially or triennially is cost-effective. These findings could be of interest to health policy makers when making decisions regarding resource allocation; however, further studies in this field are required in order to make stronger recommendations regarding cost-effectiveness.

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Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women

Value in Health ◽

10.1016/j.jval.2018.07.880 ◽

2019 ◽

Vol 22 (2) ◽

pp. 185-193 ◽

Cited By ~ 3

Author(s):

Ya-Chen Tina Shih ◽

Wenli Dong ◽

Ying Xu ◽

Yu Shen

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Average Risk ◽

Screening Guidelines ◽

The Cost

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Cost effectiveness analysis of a polygenic risk tailored breast cancer screening programme in Singapore

BMC Health Services Research ◽

10.1186/s12913-021-06396-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jerry Zeng Yang Wong ◽

Jia Hui Chai ◽

Yen Shing Yeoh ◽

Nur Khaliesah Mohamed Riza ◽

Jenny Liu ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Programme ◽

Cost Effective ◽

Polygenic Risk ◽

Breast Cancer Screening Programme ◽

Cancer Screening Programme ◽

The Cost

Abstract Background This study aimed to evaluate the cost-effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs), against the current biennial mammogram-only screening programme to aid in its implementation into the current programme in Singapore. Methods A Markov model was used to compare the costs and health outcomes of the current screening programme, against a polygenic risk-tailored screening programme, which can advise a long-term screening strategy depending on the individual’s polygenic risk. The model took the perspective of the healthcare system, with a time horizon of 40 years, following women from the age of 35 to 74. Epidemiological and cost data were taken from Asian studies, and an annual discount rate of 3% was used. The model outcome was the incremental cost-effectiveness ratio (ICER), calculated from the difference in costs per quality-adjusted life year (QALY). Scenarios with varying risk thresholds for each polygenic risk group were examined. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty. Results The ICER for a polygenic risk-tailored breast cancer screening programme, compared with the current biennial mammogram-only screening programme, was − 3713.80 SGD/QALY, with incremental costs < 0 and incremental effects > 0. The scenario analysis of different polygenic risk cutoffs showed that the ICERs remain negative, with all ICERs falling within the south-east quadrant of the cost-effectiveness plane, indicating that tailored screening is more cost effective than mammogram-only screening, with lower costs and higher QALYs to be gained. This suggests that a polygenic risk-tailored breast cancer screening programme is cost effective, entailing lower cost than the current mammogram-only programme, while causing no additional harm to women. Conclusion Results from this cost-effectiveness analysis show that polygenic risk-tailored screening is cost effective with an ICER of − 3713.80 SGD/QALY. Tailored screening remains cost effective even across varying percentile cutoffs for each risk group. While the results look promising for incorporating polygenic risk into the current breast cancer screening programme, further studies should be conducted to address various limitations.

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Costs of Breast Cancer and the Cost-Effectiveness of Breast Cancer Screening

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300007169 ◽

1991 ◽

Vol 7 (4) ◽

pp. 604-615 ◽

Cited By ~ 25

Author(s):

Anne Elixhauser

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Mass Screening ◽

Cost Effective ◽

The United States ◽

Medical Care Costs ◽

The Cost ◽

Care Costs

AbstractBreast cancer is the second leading cause of death by cancer among women in the United States. The total cost of illness for breast cancer has been estimated to be $3.8 billion, of which $1.8 billion represents medical care costs. It has been estimated that breast cancer detected early is considerably less expensive than when the tumor is discovered at a later stage. Mass screening using mammography can improve early detection by as much as 15–35%. Cost-effectiveness studies have estimated that the costs of breast cancer screening range between $13,200 and $28,000 per year of life saved. The cost-effectiveness of breast cancer screening in the 40–49-year-old age group is controversial. Mass screening for breast cancer will probably increase total health care costs, but when all economic costs are included, screening appears to be more cost-effective than not screening.

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Cost Effectiveness Analysis of a Polygenic Risk Tailored Breast Cancer Screening Programme in Singapore

10.21203/rs.3.rs-146171/v1 ◽

2021 ◽

Author(s):

Jerry Zeng Yang Wong ◽

Jia Hui Chai ◽

Yen Shing Yeoh ◽

Nur Khaliesah Mohamed Riza ◽

Jenny Liu ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Programme ◽

Cost Effective ◽

Polygenic Risk ◽

Breast Cancer Screening Programme ◽

Cancer Screening Programme ◽

The Cost

Abstract BackgroundThis study aimed to evaluate the cost effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs) in Singapore, against the current biennial mammogram only screening programme.MethodsA Markov model was used to compare the costs and health outcomes of the current screening programme, against a polygenic risk tailored screening programme that advises long term screening depending polygenic risk. The model took the perspective of the healthcare system, with a time horizon of 40 years, following women from the age of 35 to 74. Epidemiological and cost data was taken from Asian studies. An annual discount rate of 3% was used. The model outcome was the incremental cost-effectiveness ratio (ICER), calculated from the difference in costs per quality adjusted life year (QALY). Scenarios with varying risk thresholds for each polygenic risk group were examined. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty.ResultsThe ICER for a polygenic risk tailored breast cancer screening programme, compared to the current biennial mammogram only screening programme, was -3,713.80, with incremental costs <0 and incremental effects >0. Scenario analysis of different polygenic risk cutoffs showed that the ICERs remain negative, with all ICERs falling within the south east quadrant of the cost effectiveness plane, indicating that tailored screening dominates mammogram only screening with lower costs and higher QALYs. This suggests that a polygenic risk tailored breast cancer screening programme is cost effective, being cheaper than the current mammogram only programme while bringing no additional harm to women.ConclusionResults from this cost effectiveness analysis show that polygenic risk tailored screening is cost effective with an ICER of –3,713.80 SGD/QALY. Tailored screening remains cost effective even when varying percentile cutoffs for each risk group. While the results look promising for incorporating polygenic risk into the current breast cancer screening programme, further studies should be conducted due to various limitations.

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Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6060 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6060-6060 ◽

Cited By ~ 1

Author(s):

S. G. Moore ◽

J. Tumeh ◽

C. R. Flowers

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

High Risk ◽

Breast Cancer Screening ◽

Young Women ◽

Breast Mri ◽

Cost Effective ◽

Net Benefit ◽

The Cost

6060 Background: Breast magnetic resonance imaging (MRI) is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high. The purpose of this study was to determine if breast MRI is a cost-effective approach for the detection of breast cancer among young women at high risk. Methods: A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. The analysis was performed from the payer perspective with results reported in 2005 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. Results: Breast MRI provided 23.287 quality-adjusted life-years (QALYs) at a cost of $30,317 while mammography provided 23.141 QALYs at a cost of $7,895 over 25 years of screening. The cost-effectiveness ratios for the two strategies were $1302 and $341, respectively. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $131,376/QALY. In univariate analysis, breast MRI screening became <$50,000/QALY when the cost of the MRI was <$405. In the probabilistic sensitivity analysis, MRI screening produced a net benefit of +0.146 QALYs (95% central range: -0.825 QALYs to +1.378 QALYs). However, breast MRI screening was superior in <1%, <$50,000/QALY in 27%, >$50,000/QALY in 32%, and inferior in 41% of 10,000 probabilistic Monte Carlo simulations. Conclusions: Breast MRI provides a net benefit when compared to mammographic screening for high risk women, however, this approach does not appear to be cost-effective at this time. No significant financial relationships to disclose.

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

The European Journal of Health Economics ◽

10.1007/s10198-021-01338-5 ◽

2021 ◽

Author(s):

Nikolai Mühlberger ◽

Gaby Sroczynski ◽

Artemisa Gogollari ◽

Beate Jahn ◽

Nora Pashayan ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Cost Effectiveness ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cancer Screening And Prevention ◽

Screening And Prevention

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Can polygenic risk scores contribute to cost-effective cancer screening? A systematic review

10.1101/2021.11.26.21266911 ◽

2021 ◽

Author(s):

Padraig Dixon ◽

Edna Keeney ◽

Jenny C Taylor ◽

Sarah Wordsworth ◽

Richard Martin

Keyword(s):

Systematic Review ◽

Health Economic ◽

Cost Effectiveness ◽

Cancer Screening ◽

Cost Effective ◽

Risk Scores ◽

Polygenic Risk ◽

The Cost ◽

Economic Studies

Polygenic risk is known to influence susceptibility to cancer. The use of data on polygenic risk, in conjunction with other predictors of future disease status, may offer significant potential for preventative care through risk-stratified screening programmes. An important element in the evaluation of screening programmes is their cost-effectiveness. We undertook a systematic review of papers evaluating the cost-effectiveness of screening interventions informed by polygenic risk scores compared to more conventional screening modalities. We included papers reporting cost-effectiveness outcomes in the English language published as articles or uploaded onto preprint servers with no restriction on date, type of cancer or form of polygenic risk modelled. We excluded papers evaluating screening interventions that did not report cost-effectiveness outcomes or which had a focus on monogenic risk. We evaluated studies using the Quality of Health Economic Studies checklist. Ten studies were included in the review, which investigated three cancers: prostate (n=5), colorectal (n=3) and breast (n=2). All study designs were cost-utility papers implemented as Markov models (n=6) or microsimulations (n=4). Nine of ten papers scored highly (score >75 on a 0-100) scale) when assessed using the Quality of Health Economic Studies checklist. Eight of ten studies concluded that polygenic risk informed cancer screening was likely to be more cost-effective than alternatives. However, the included studies lacked robust external data on the cost of polygenic risk stratification, did not account for how very large volumes of polygenic risk data on individuals would be collected and used, did not consider ancestry-related differences in polygenic risk, and did not fully account for downstream economic sequalae stemming from the use of polygenic risk data in these ways. These topics merit attention in future research on how polygenic risk data might contribute to cost-effective cancer screening.

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