Cost-effectiveness of breast cancer screening: Preliminary results of a systematic review of the literature

Abstract

There is now considerable concern that universal access to health care within realistic resource constraints requires some sort of cost-effectiveness analysis of given medical procedures and interventions. One such intervention is routine mammographic screening for breast cancer. Here, we report preliminary results from an ongoing project to conduct a systematic and comprehensive review and comparison of the published cost-effectiveness analyses of screening for the early detection of breast cancer. We examine 16 such studies, and compare two studies in detail to explain how differences in assumptions and in consideration of down-stream effects have caused the published results for apparently comparable breast cancer screening programs to span a broad range.

Cost effectiveness of mammography screening for Chinese women

“…Of the 5 strategies that we considered, our findings suggest that, although biennial mammography for all women ages 40 years to 69 years would be the least costly, nondominated screening option, the incremental cost (compared with no screening) of US$64,400 per LYS or US$61,600 per QALY is greater than the corresponding ratios in the West, as reported previously, [6][7][8][9] and seems to be slightly greater than the typical threshold used for new technology adoption by many advanced economies. [43][44][45][46][47][48] Although there is no consensus on what constitutes an acceptable ICER, the U.K.'s National Institute for Health and Clinical Excellence (NICE) typically has accepted technologies as cost effective if the ICERs are below US$36,000 to US$54,000 (US$1 5 £0.55) per QALY, although NICE has (very rarely) accepted technologies (not related to screening) with larger ICERs up to US$90,000.…”

“…5 Prior cost-effectiveness studies also justified screening on economic grounds. [6][7][8][9] Although breast cancer is responsible for the majority of new malignancies among Hong Kong Chinese women 10 with a rising incidence, 11 it remains at only approximately 50% of the incidence among Caucasians. 12 Even assuming that the survival benefit of mammog-raphy scales linearly at a lower prevalence at screening, this different epidemiologic burden immediately translates into a reduced positive predictive value, 13 thus casting doubt on the generalizability of effectiveness and efficiency estimates among non-Chinese populations.…”

Economic evaluation of cancer treatments

“…At present, efforts are being made to develop such a methodology further (Mugford et al, 1994). There is probably only one overview on the economics of cancer literature where an attempt has been made at generalising results of different studies (Brown and Fintor, 1993). In this overview Brown and Fintor examined the cost-effectiveness of screening for breast cancer and used a computerised model to 'reconcile' differences in cost-effectiveness ratios from two studies.…”

Developing Evidence-Based Clinical Practice Guidelines: Lessons Learned by the US Preventive Services Task Force

“…Third, the science of evaluating the cost-effectiveness of preventive services was not sufficiently mature to justify valid comparisons of cost-effectiveness across different preventive services or between preventive and curative services ( 1 8, 66). Estimates of the cost-effectiveness of breast cancer screening, for example, have varied between $3400 to over $83,000 per life-year saved (10).…”