COST-EFFECTIVENESS OF RISK-BASED STRATIFIED BREAST CANCER SCREENING

Purpose: A targeted breast cancer screening programme using individual risk-based screening intervals has the potential to effectively distribute healthcare resources to maximise patient benefits by tailoring the frequency at which women are screened. A research program comprising ‘The Predicting Risk of Cancer at Screening (PROCAS)’ study was designed to improve breast cancer risk prediction methods to inform this targeted screening interval using data collected from over 50,000 women in the Greater Manchester Region UK. A further aim was to identify the incremental costs and patient benefits of a proposed risk-based screening policy in comparison with the current established screening programme.

Method(s): A discrete event simulation model was structured to represent key events over the life course of a cohort of individual women participating in a screening programme.  Assuming the healthcare perspective the model compared a risk-based screening intervals with the current programme in terms of total costs of screening and treatment for breast cancer and quality-adjusted life-years (QALYs). The model has three components representing: 1) the natural history of breast cancer; 2) the screening programme; and 3) treatment for breast cancer. The parameters were populated using primary PROCAS data, supplemented with expert opinion and structured reviews of the literature.

Result(s): Our analysis suggests that a risk-based screening programme is a cost-effective use of healthcare resources in terms of incremental cost per-QALY gain when compared with the current screening programme. The model predictes the impact of adapting the screening interval in accordance with the risk-based screening strategy and indicated further increases in the incidence of screen detected breast cancer accompanied with reductions in interval detected breast cancer with subsequent reductions in breast cancer mortality.

Conclusion(s): This economic evaluation suggests a risk-based breast screening programme has the potential to improve screening outcomes in terms of a reduction in mortality with an acceptable impact on healthcare resources.