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

Abstract

Systematic reviews with economic components are important decision tools for stakeholders seeking to evaluate technologies, such as breast cancer screening (BCS) programs. This overview of systematic reviews explores the determinants of the cost‐effectiveness of BCS and assesses the quality of secondary evidence. The search identified 30 systematic reviews that reported on the determinants of the cost‐effectiveness of BCS, including the costs of breast cancer and BCS. While the quality of the reviews varied widely, only four out of 30 papers were considered to be of a high quality. We did not identify publication bias in the original evidence on the cost‐effectiveness of mammography screening; however, we highlight a need for improved clarity in both reporting and data verification. The reviews consisted mainly of studies from high‐income countries. Breast cancer costs varied widely among the studies. Factors leading to higher costs included: time (diagnosis and last months before death), later stage or metastases, recurrence of the disease, age below 64 years and type of follow‐up (more intensive or more specialized). Overall, screening with mammography was considered cost‐effective in the age range 50‐69 years in Western European and Northern American countries but not for older or younger women. Its cost‐effectiveness was questionable for low‐income settings and Asia. Mammography screening was more cost‐effective with biennial screening compared to annual screening and single reading using computer‐aided detection vs double reading. No information on the cost‐effectiveness of ultrasonography was found, and there is much uncertainty on the cost‐effectiveness of CBE because of methodological limitations.

Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review

“…When a comparison was made between biennial screening and annual or triennial screening, a biennial interval was found to be more cost-effective than the other screening interval strategies. This is in line with the conclusion of the review of systematic reviews by Mandrik et al [18] as well as the WHO recommendation of a screening interval of two years among women aged 50-69 years in well-resourced settings or limited resource settings with relatively strong health systems [1]. This recommendation was based on modelling studies and further analysis of trials showed that screening every two years seems to provide the best trade-off between benefits (mortality reduction) and harms (overdiagnosis or overtreatment).…”

Systematic reviews as a “lens of evidence”: Determinants of participation in breast cancer screening

“…Since implementation of BCS programs has already stimulated multiple discussions about their benefit/harm ratio and cost-effectiveness, 47 , 48 understanding how much support these programs gain from various groups, such as the medical community and the women themselves, can be an important parameter defining the programs’ priority on the political agenda. This is especially crucial for countries considering implementation of a population-wide screening program, re-assessing continuation of the existing program, or evaluating screening extension to other age groups.…”

Network Meta-analysis for the Diagnostic Approach to Pathologic Nipple Discharge

“…Ultrasound and mammogram are established, cheap breast imaging methods. 66,67 We found that the pooled average sensitivity for the detection of breast cancer in patients with PND was 50% for ultrasound but only 22% for mammogram. Pooled specificity was 69% for ultrasound but much was higher, at 93%, for mammogram.…”