TY - JOUR
T1 - Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women
AU - Tina Shih, Ya Chen
AU - Dong, Wenli
AU - Xu, Ying
AU - Shen, Yu
N1 - Funding Information:
Source of financial support: This work was supported in part by grants from the National Cancer Institute (grant no. R21CA165092 to Y.-C. T. Shih and Y. Shen; grant no. R01CA079466 to Y. Shen), the Agency for Healthcare Research and Quality (grant no. R01HS020263 to Y.-C. T. Shih), and the Duncan Family Institute. The interpretation and reporting of study findings are the sole responsibility of the authors.
Funding Information:
We thank Ms LeeAnn Chastain from the Department of Biostatistics at The University of Texas MD Anderson Cancer Center for reviewing and editing the manuscript. We also acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. This study used the linked SEER-Medicare database. Y.-C. T. Shih is a member of the American Cancer Society Cancer Screening Guideline Development Group and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Source of financial support: This work was supported in part by grants from the National Cancer Institute (grant no. R21CA165092 to Y.-C. T. Shih and Y. Shen; grant no. R01CA079466 to Y. Shen), the Agency for Healthcare Research and Quality (grant no. R01HS020263 to Y.-C. T. Shih), and the Duncan Family Institute. The interpretation and reporting of study findings are the sole responsibility of the authors.
Publisher Copyright:
© 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research
PY - 2019/2
Y1 - 2019/2
N2 - Background: Several specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016. Objectives: To evaluate the cost-effectiveness of US-based mammography screening guidelines. Methods: We developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier. Results: The screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older. Conclusions: The screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system's investment in the early detection and treatment of breast cancer.
AB - Background: Several specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016. Objectives: To evaluate the cost-effectiveness of US-based mammography screening guidelines. Methods: We developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier. Results: The screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older. Conclusions: The screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system's investment in the early detection and treatment of breast cancer.
KW - breast cancer screening guidelines
KW - cost-effectiveness analysis
KW - microsimulation models
KW - screening mammography
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U2 - 10.1016/j.jval.2018.07.880
DO - 10.1016/j.jval.2018.07.880
M3 - Article
C2 - 30711063
AN - SCOPUS:85052994666
SN - 1098-3015
VL - 22
SP - 185
EP - 193
JO - Value in Health
JF - Value in Health
IS - 2
ER -