Evaluation of a Stratified National Breast Screening Program in the United Kingdom: An Early Model-Based Cost-Effectiveness Analysis

Evaluation of a Stratified National Breast Screening Program in the United Kingdom: An Early Model-Based Cost-Effectiveness Analysis. Gray, E., Donten, A., Karssemeijer, N., van Gils, C., Evans, D. G., Astley, S., & Payne, K. Value in Health, 20(8):1100–1109, September, 2017.

Paper doi abstract bibtex

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.

@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},
}

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