Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer
Vilaprinyó, Ester (Institut de Recerca Biomèdica de Lleida)
Forné, Carles (Universitat de Lleida. Departament de Ciències Mèdiques Bàsiques)
Carles-Lavila, Misericòrdia (Universitat Rovira i Virgili)
Sala, Maria (Parc de Salut MAR de Barcelona)
Pla, Roger (Universitat Rovira i Virgili. Departament de Cirurgia)
Castells, Xavier (Parc de Salut MAR de Barcelona)
Domingo, Laia (Parc de Salut MAR de Barcelona)
Rué, Montserrat (Universitat de Lleida. Departament de Ciències Mèdiques Bàsiques)
Interval Cancer (INCA) Study Group

Data:	2014
Resum:	The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.
Nota:	Altres ajuts: NCI/U01CA63740
Nota:	Altres ajuts: NCI/U01CA86076
Nota:	Altres ajuts: NCI/U01CA86082
Nota:	Altres ajuts: NCI/U01CA63736
Nota:	Altres ajuts: NCI/U01CA70013
Nota:	Altres ajuts: NCI/U01CA69976
Nota:	Altres ajuts: NCI/U01CA63731
Nota:	Altres ajuts: NCI/U01CA70040
Nota:	Altres ajuts: NCI/HHSN261201100031C
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 9 Issue 2 (Febrer 2014) , p. 1-10, ISSN 1932-6203

DOI: 10.1371/journal.pone.0086858
PMID: 24498285

10 p, 1.9 MB

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