Is screening for breast cancer cost-effective?

Mushlin, Alvin I.; Fintor, Lou

doi:10.1002/1097-0142(19920401)69:7+<1957::aid-cncr2820691716>3.0.co;2-t

Cited by 71 publications

(22 citation statements)

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“…The issues here are somewhat complex, but it is evident that, with suitable specifications of both the screening and its recipients, the cost of life-year saved can be as low as $10,000 or even lower [19]. Such a cost per life-year saved is well below that for existing programs of screening for breast cancer [20] or cervical cancer [21] and well below the benchmark of $50,000 used in the U.S.…”

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confidence: 99%

Early Lung Cancer Action Project: A Summary of the Findings on Baseline Screening

et al. 2001

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Purpose. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer.Methods. Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term highresolution CT follow-up for the smallest nodules.Baseline Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA. Telephone: 212-746-2529; Fax: 212-746-2811 Received October 10, 2000 accepted for publication February 23, 2001. ©AlphaMed Press 1083-7159/2001 INTRODUCTIONIn the United States, the cure rate of lung cancer is a dismal 10%, and the 5-year survival rate is only slightly higher than the cure rate. In stage I lung cancer, by contrast, the 5-year survival rate upon resection is as high as 70%; but if left unresected, that rate is again of the order of a mere 10% [1,2]. While these rates imply that the cure rate of lung cancer can be substantially enhanced by screening and its associated earlier intervention, results of randomized trials have been interpreted as indicating that this is not the case [3].This paradox points to the possibility that the negative results of the randomized trials were a consequence of flaws in their design, execution and/or analysis. To quantify the

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confidence: 99%

Early Lung Cancer Action Project: A Summary of the Findings on Baseline Screening

et al. 2001

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“…Cost saving 4575/QALY Low-dose zidovudine therapy for asymptomatic HIV infectioncontinuous effect (Schulman et al 1991) 7800/LY Coronary artery bypass, left main disease plus angina (Weinstein and Stason 1982) 8100/QALY THA-first 3 years following surgery (Laupacis et al 1994) 8700/QALY Hydrochlorothiazide for hypertension (Edelson et al 1990) 24,900/LY Screening mammography, women ≥ 50 y (Mushlin and Fintor 1992) 20,000-50,000/LY Coronary artery bypass, two-vessel disease plus angina (Weinstein and Stason 1982) 37,400/QALY Renal dialysis, in-center benefit, men (Garner and Dardis 1987) 59,400-68,300/LY Low-dose zidovudine therapy for asymptomatic HIV-one time effect (Schulman et al 1991) 83,600/LY Cholestyramine for high cholesterol (Kinosian and Eisenberg 1988) 91,200/LY Captopril for hypertension (Edelson et al 1990) 98,100/LY Autologous blood donations for elective THA (Etchason et al 1995) 218,800/QALY Screening mammography, women < 50 y (Eddy et al 1988 …”

Section: Resultsmentioning

confidence: 99%

Stochastic-Tree Models in Medical Decision Making

Hazen

Pellissier²,

Sounderpandian

1998

Interfaces

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Abstract:The stochastic tree is a recently introduced generalization of the decision tree which allows the explicit depiction of temporal uncertainty, while still employing the familiar rollback procedure for decision trees. We offer in this paper an introduction to stochastic tree modeling and techniques involved in their application to medical treatment decisions. We also describe an application of these tools to the analysis of the decision to undergo a total hip replacement from the perspectives of an individual patient (via utility analysis) and of society (via cost-effectiveness analysis). For medical analyses, the most commonly used method for the formulation and display of discrete-time Markov chains is the Markov cycle tree developed by Hollenberg [1984]. Hazen [1992] introduced a continuous-time analog of the Markov-cycle tree, the stochastic tree, which combines features of decision trees [Raiffa 1968] and stochasticprocess transition diagrams. Stochastic tree diagrams not only can depict continuously distributed temporal uncertainties, but, like decision trees, can be rolled back to determine optimal decisions. This rollback procedure is an instance of the method of successive approximations from stochastic dynamic programming (Denardo [1982], Ross [1970]). It can be applied not only for risk-neutral objective functions, such as mean quality adjusted lifetime [Hazen 1992], but also for the calculation of expected utility .One of the first applications of stochastic tree modeling in medical decision making was an investigation of total hip replacement surgery for patients with severe osteoarthritis 4 (OA) of the hip. An estimated 120,000 hip replacements are performed per year in North America [Harris and Sledge 1990]. This decision is interesting from a number of points of view. Although total hip replacement surgery (total hip arthroplasty, THA) is the most successful procedure for patients with advanced arthritis of the hip, the treatment decision for an individual patient with this condition can be difficult. While the surgery offers the potential of increased quality of life, it carries additional risk of mortality and morbidity.From a societal perspective, given the increasing incidence of severe osteoarthritis of the hip, the growing demand for THA, and the high costs associated with the procedure, there is concern that a larger share of health care resources will be spent on THA in the future.Rising costs and attempts to improve the efficiency of health care delivery have stimulated the need for analyses that objectively examine the trade-offs between therapeutic benefits and expenditures. If the economic consequences of surgical interventions are included, procedures such as THA are particularly vulnerable to scrutiny for several reasons. First, it is an elective procedure. Second, its target population is largely geriatric. Third, it is an expensive, high-technology procedure. Finally, in terms of short-term costs alone, medical management would appear to represent a less expensive treatment...

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“…Se estima que el riesgo teórico de la radiación por una Mx de screening es extremadamente pequeño comparado con el beneficio del procedimiento; la relación vida salvada/vida perdida es de 48,5 y se ganarían 121,3 años de vida por la pérdida de una (39,40) . En cuanto a los costos, se han hecho múltiples estudios de evaluación económica de programas de salud, que tienen como objetivo tomar decisiones sobre el uso de los recursos disponibles: hasta ahora, la Mx de screening no representa un ahorro económico a corto o largo plazo, pero se encuentra en el rango de otros procedimientos preventivos aceptados (41,42,43) .…”

Section: Efectos Adversos Y Costosunclassified

Mamografia De Screening Y Realidad Chilena

2008

Rev. chil. radiol.

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IntroducciónEl cáncer de mama es una enfermedad de alta prevalencia en el mundo entero. Lo mismo ocurre en nuestro país, donde constituye la segunda causa de muerte por tumores malignos en mujeres y su tasa de mortalidad alcanza 13,3/ 100 mil mujeres (1) . Se sabe que el cáncer mamario detectado precozmente tiene una excelente sobrevida, alcanzando hasta un 98% a 10 años. El diagnóstico precoz ofrece además a la paciente la posibilidad de una cirugía menos mutilante y permite disminuir la morbi-mortalidad asociada a los tratamientos complementarios, como la radioterapia y quimioterapia.La forma de diagnosticarlo precozmente se ha discutido extensamente en la literatura, existiendo varios métodos para hacerlo: el auto-examen, el examen clínico, la mamografía (Mx) y los exámenes complementarios convencionales y emergentes (ej. ecotomografía, resonancia mamaria, TAC, PET, cintigrafía, elastografía, tomosíntesis, angiomamografía etc.).Dentro de los métodos de detección precoz de cáncer mamario, el único que ha demostrado hasta el momento beneficios en cuanto a la reducción de la mortalidad, es la mamografía.A continuación revisaremos la evidencia existente, los tópicos más polémicos, las recomendaciones y la realidad chilena. Mamografía de screeningA partir de los años sesenta, se diseñaron varios estudios clínicos para intentar responder si la Mx como método de screening tenía algún efecto sobre la mortalidad por cáncer de mama, en comparación con otras estrategias, tales como el auto-examen mamario y el examen físico mamario.Ocho estudios randomizados han evaluado la efectividad de la Mx: en Estados Unidos (2, 3) , Suecia (4)(5)(6)(7)(8) , en el Reino Unidos (9) y Canadá (10,11) . Se ha reclutado más de medio millón de mujeres, con seguimiento de más de 20 años, y se han realizado varios metaanálisis. Seis de los trabajos mencionados examinan la efectividad del screening en mujeres entre 40 a 74 años; uno enrola a mujeres de 40 años y sólo uno a mujeres de 50 años. Todos los estudios han sido ampliamente criticados por el sesgo de selección, tamaño de la muestra, técnicas, mamógrafos no

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Is screening for breast cancer cost-effective?

Cited by 71 publications

References 8 publications

Early Lung Cancer Action Project: A Summary of the Findings on Baseline Screening

Early Lung Cancer Action Project: A Summary of the Findings on Baseline Screening

Stochastic-Tree Models in Medical Decision Making

Mamografia De Screening Y Realidad Chilena

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