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

Abstract

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.

Systematic reviews as a “lens of evidence”: Determinants of cost‐effectiveness of breast cancer screening

“…37,[39][40][41] Six reviews, mainly based on the same original evidence, reported resource use or costs of breast cancer follow-up (Appendix 5). 22,30,35,[42][43][44] The highest rate of resource use was for follow-up visits and follow-up mammography, 44 while the frequency of visits decreased twice in the initial 4 years after F I G U R E 2 The conceptual framework of the review treatment. 43 The follow-up costs could be affected by poor continuity of the doctor-patient relationship, with patients seeing multiple doctors during the follow-up and doing almost twice the recommended number of visits.…”

“…47 Another review estimated the costs of personalizing screening intervals considering an individual's cancer risk, concluding higher cost (2000-2500 USD, 2014) for a higher risk population. 42 While mammography was a target intervention in most of the reviews, three publications reported BCS costs for the other screening approaches ( Table 1). Zelle et al (2013) reported that CBE can be a cost-effective screening method for some low-income settings (India, Ghana, and Egypt).…”

Cost‐effectiveness of risk‐based breast cancer screening: A systematic review

“…Cost and utility effects of risk‐stratification are largely ignored. A full systematic review of simulation models for stratified BC screening conducted by Arnold 23 suggests that risk‐stratification has no considerable cost implication but being declared high‐risk could significantly reduce QoL. We identified two studies 32,33 where results suggest that an increase in the cost of risk stratification might cause the risk‐based strategy not to be cost‐effective compared to ABS (WTP threshold £30 000/QALY gained).…”

“…To our knowledge, two systematic reviews have been published. Arnold 23 conducted a literature review focussing on the analysis of modelling techniques. Roman et al 24 reviewed previous studies on the effectiveness of RBS and the risk of bias.…”

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

“…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.…”