scholarly journals Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening

2021 ◽  
Vol 11 ◽  
Author(s):  
Fabian Tollens ◽  
Pascal A. T. Baltzer ◽  
Matthias Dietzel ◽  
Moritz L. Schnitzer ◽  
Wolfgang G. Kunz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Sensitivity Analyses ◽  
Intermediate Risk ◽  
Mr Mammography ◽  
Markov Modelling ◽  
The Cost ◽  
The Impact

ObjectivesTo evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.MethodsDecision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.ResultsBreast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.ConclusionsBased on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.

scholarly journals The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis

CMAJ Open ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. E443-E450
Author(s):  
Sonya Cressman ◽  
Colin Mar ◽  
Janette Sam ◽  
Lisa Kan ◽  
Caroline Lohrisch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Economic Analysis ◽  
Breast Cancer Screening ◽  
The Cost

scholarly journals Modeling the Cost-Effectiveness of Alternative Upper Age Limits for Breast Cancer Screening in England and Wales

2016 ◽  
Vol 19 (4) ◽  
pp. 404-412 ◽  
Author(s):  
Rachid Rafia ◽  
Alan Brennan ◽  
Jason Madan ◽  
Karen Collins ◽  
Malcolm W.R. Reed ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
England And Wales ◽  
Age Limits ◽  
The Cost

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

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.

scholarly journals Cost-effectiveness analysis of radiotherapy techniques for whole breast irradiation

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248220
Author(s):  
Yibo Xie ◽  
Beibei Guo ◽  
Rui Zhang
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Advanced Technology ◽  
Sensitivity Analyses ◽  
Tumor Control ◽  
Life Years ◽  
Whole Breast Radiotherapy ◽  
The Cost ◽  
The Impact

Background The current standard of care (SOC) for whole breast radiotherapy (WBRT) in the US is conventional tangential photon fields. Advanced WBRT techniques may provide similar tumor control and better normal tissue sparing, but it is controversial whether the medical benefits of an advanced technology are significant enough to justify its higher cost. Objective To analyze the cost-effectiveness of six advanced WBRT techniques compared with SOC. Methods We developed a Markov model to simulate health states for one cohort of women (65-year-old) with early-stage breast cancer over 15 years after WBRT. The cost effectiveness analyses of field-in-field (FIF), hybrid intensity modulated radiotherapy (IMRT), full IMRT, standard volumetric modulated arc therapy (STD-VMAT), multiple arc VMAT (MA-VMAT), non-coplanar VMAT (NC-VMAT) compared with SOC were performed with both tumor control and radiogenic side effects considered. Transition probabilities and utilities for each health state were obtained from literature. Costs incurred by payers were adopted from literature and Medicare data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. One-way sensitivity analyses and probabilistic sensitivity analyses (PSA) were performed to evaluate the impact of uncertainties on the final results. Results FIF has the lowest ICER value of 1,511 $/QALY. The one-way analyses show that the cost-effectiveness of advanced WBRT techniques is most sensitive to the probability of developing contralateral breast cancer. PSAs show that SOC is more cost effective than almost all advanced WBRT techniques at a willingness-to-pay (WTP) threshold of 50,000 $/QALY, while FIF, hybrid IMRT and MA-VMAT are more cost-effective than SOC with a probability of 59.2%, 72.3% and 72.6% at a WTP threshold of 100,000 $/QALY, respectively. Conclusions FIF might be the most cost-effective option for WBRT patients at a WTP threshold of 50,000 $/QALY, while hybrid IMRT and MA-VMAT might be the most cost-effective options at a WTP threshold of 100,000 $/QALY.

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