Abstract

Background

Breast cancer screening technology and treatment have improved over the past decade. This analysis evaluates the total cost-effectiveness of various breast cancer screening strategies in Canada.

Data and methods

Using the Wisconsin Cancer Intervention and Surveillance Monitoring Network (CISNET) breast cancer simulation model adapted to the Canadian context, costs and quality-adjusted life years (QALY) were evaluated for 11 mammography screening strategies that varied by start/stop age and screening frequency for the general population. Incremental cost-effectiveness ratios are presented, and sensitivity analyses are used to assess the robustness of model conclusions.

Results

Incremental cost-effectiveness analysis showed that triennial screening at ages 50 to 69 was the most cost-effective at $94,762 per QALY. Biennial ($97,006 per QALY) and annual ($226,278 per QALY) strategies had higher incremental ratios.

Interpretation

The benefits and costs of screening rise with the number of screens per woman. Decisions about screening strategies may be influenced by willingness to pay and the rate of recall for further examination after positive screens.

Keywords

Breast screening, economic analysis, microsimulation model, preventive health

Findings

Implementation of screening programs can have significant budget implications, depending on the size of the population affected and the health care system resources involved. Recommendations for mammography screening are continually being updated and modified—the age range, frequency, effectiveness and cost-effectiveness of population-wide screening are ongoing topics of debate. Decisions about whether to screen, who should be screened, what modalities to use, and how frequently to screen are best made when the trade-offs between improved health outcomes, potential harm, and the economic impact are understood. [Full Text]

Authors

This work was conducted while Nicole Mittmann (nicole.mittmann@sri.utoronto.ca) was at the Health Outcomes and PharmacoEconomic (HOPE) Research Centre at Sunnybrook Research Institute and the University of Toronto. Natasha K. Stout is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute. Pablo Lee is with the Institute for Technology Assessment, Massachusetts General Hospital. Anna N.A. Tosteson is with the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth. Amy Trentham-Dietz is with the Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin. Oguzhan Alagoz is with the Department of Industrial and Systems Engineering and the Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin. Martin J. Yaffe is with the Physical Sciences Program, Sunnybrook Research Institute, and the Departments of Medical Biophysics and Medical Imaging, University of Toronto.

Start of text box

 

What is already known on this subject?

  • Early diagnosis of breast cancer through screening mammography can save lives, but costs and possible harms are associated with the screening and subsequent treatment.
  • Implementation of screening programs have substantial budget implications, depending on the size of the population affected and the health care system resources involved.
  • Studies have estimated the costs of breast cancer treatment from the Canadian perspective, but none have examined or incorporated the full cost of screening, including lost productivity.

What does this study add?

  • This analysis evaluates the costs, outcomes and cost effectiveness of different mammography strategies, using a validated breast cancer simulation model.
  • The main cost driver of the active screening strategies was the frequency of screening.
  • Narrower age groups and less frequent screening were optimal when cost effectiveness was considered.

End of text box

Date modified: