Cost-Effectiveness Models in Breast Cancer Screening in the General Population: A Systematic Review

Schiller-Frühwirth, I.; Jahn, Beate; Arvandi, Marjan; Siebert, Uwe

doi:10.1007/s40258-017-0312-3

Cited by 20 publications

(20 citation statements)

References 101 publications

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“…In situ carcinoma may or may not progress to invasive cancers. Schiller-Fruhwirth et al [ 53 ] identified the uncertainty about the biological relation between in situ and invasive cancers to be the root of the differences in modeling. However, treatment guidelines usually recommend treatment of in situ cancers [ 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Simulation modeling for stratified breast cancer screening – a systematic review of cost and quality of life assumptions

Arnold

2017

BMC Health Serv Res

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BackgroundThe economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care.MethodsA literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters.ResultsEighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias.ConclusionThis systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2766-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Simulation modeling for stratified breast cancer screening – a systematic review of cost and quality of life assumptions

Arnold

2017

BMC Health Serv Res

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“…being justified. The mean size of effect pooled from randomised controlled trials (RCTs) is 15-25%, 6,9,11,16,19,20,25,30,[33][34][35][36][37] from models/estimates is 11-33%, [33][34][35] and from observational/ population evidence is 28-56%. 9,25,36 The Cochrane review reported statistically non-significant all-cancer mortality reduction.…”

Section: Screening Mammographymentioning

confidence: 99%

Systematic reviews as a ‘lens of evidence’: Determinants of benefits and harms of breast cancer screening

Mandrik

Zielonke

Meheus

et al. 2019

Intl Journal of Cancer

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This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15–25% in trials and 28–56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1–60% in trials and 1–12% in studies with a low risk of bias, and cumulative false‐positive rates were lower with biennial than annual screening (3–17% vs 0.01–41%). There is no consistency in the reviews’ conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen‐film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54–84% and 47–69%, respectively), and strong evidence of unfavourable benefit‐to‐harm ratio with breast self‐examination. The reviews’ conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high‐income countries, systematically disagree on the interpretation of the benefit‐to‐harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.

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“…Two systematic reviews (19,132) have previously explored the outcomes of economic evaluations relating to breast screening programmes. Schiller-Fruhwirth et al (19) reported on the lack of breast screening specific utilities and insufficient reporting of validation in their review of economic models.…”

Section: Principal Findingsmentioning

confidence: 99%

“…The quality of the HSUVs applied is particularly pertinent in the appraisal of oncological interventions, where quality of life may have greater influence on QALYs than the modest gains in life expectancy (17). Many studies have evaluated the cost-effectiveness of breast cancer screening (18,19), with those including quality of life in their evaluation reporting fewer net benefits, yet few have commented on the quality of the utility estimates used to inform them. When deciding on preferred screening policy it is critical to be able to accurately value the options available to women of being able to attend routine screening (20).…”

Section: Introductionmentioning

confidence: 99%

Valuing the health states associated with breast cancer screening programmes: A systematic review of economic measures

Bromley

Petrie

Mann

et al. 2019

Social Science & Medicine

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Cost-Effectiveness Models in Breast Cancer Screening in the General Population: A Systematic Review

Cited by 20 publications

References 101 publications

Simulation modeling for stratified breast cancer screening – a systematic review of cost and quality of life assumptions

Simulation modeling for stratified breast cancer screening – a systematic review of cost and quality of life assumptions

Systematic reviews as a ‘lens of evidence’: Determinants of benefits and harms of breast cancer screening

Valuing the health states associated with breast cancer screening programmes: A systematic review of economic measures

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