@article{gray_evaluation_2017-1, title = {Evaluation of a {Stratified} {National} {Breast} {Screening} {Program} in the {United} {Kingdom}: {An} {Early} {Model}-{Based} {Cost}-{Effectiveness} {Analysis}}, volume = {20}, issn = {10983015}, shorttitle = {Evaluation of a {Stratified} {National} {Breast} {Screening} {Program} in the {United} {Kingdom}}, url = {https://linkinghub.elsevier.com/retrieve/pii/S1098301517302127}, doi = {10.1016/j.jval.2017.04.012}, abstract = {Objectives: To identify the incremental costs and consequences of stratified national breast screening programs (stratified NBSPs) and drivers of relative cost-effectiveness. Methods: A decision-analytic model (discrete event simulation) was conceptualized to represent four stratified NBSPs (risk 1, risk 2, masking [supplemental screening for women with higher breast density], and masking and risk 1) compared with the current UK NBSP and no screening. The model assumed a lifetime horizon, the health service perspective to identify costs (£, 2015), and measured consequences in quality-adjusted lifeyears (QALYs). Multiple data sources were used: systematic reviews of effectiveness and utility, published studies reporting costs, and cohort studies embedded in existing NBSPs. Model parameter uncertainty was assessed using probabilistic sensitivity analysis and one-way sensitivity analysis. Results: The base-case analysis, supported by probabilistic sensitivity analysis, suggested that the risk stratified NBSPs (risk 1 and risk-2) were relatively cost-effective when compared with the current UK NBSP, with incremental cost-effectiveness ratios of £16,689 per QALY and £23,924 per QALY, respectively. Stratified NBSP including masking approaches (supplemental screening for women with higher breast density) was not a cost-effective alternative, with incremental cost-effectiveness ratios of £212,947 per QALY (masking) and £75,254 per QALY (risk 1 and masking). When compared with no screening, all stratified NBSPs could be considered cost-effective. Key drivers of cost-effectiveness were discount rate, natural history model parameters, mammographic sensitivity, and biopsy rates for recalled cases. A key assumption was that the risk model used in the stratification process was perfectly calibrated to the population. Conclusions: This early model-based costeffectiveness analysis provides indicative evidence for decision makers to understand the key drivers of costs and QALYs for exemplar stratified NBSP.}, language = {en}, number = {8}, urldate = {2021-04-28}, journal = {Value in Health}, author = {Gray, Ewan and Donten, Anna and Karssemeijer, Nico and van Gils, Carla and Evans, D. Gareth and Astley, Sue and Payne, Katherine}, month = sep, year = {2017}, pages = {1100--1109}, file = {Gray et al. - 2017 - Evaluation of a Stratified National Breast Screeni.pdf:/Users/neil.hawkins/Zotero/storage/Q374ZPCQ/Gray et al. - 2017 - Evaluation of a Stratified National Breast Screeni.pdf:application/pdf}, }