The impact of a breast cancer screening programme on quality‐adjusted life‐years

Abstract

Trials have shown that breast cancer screening is effective in reducing breast cancer mortality and gaining life-years. The question is whether taking into account the impact of a screening programme on quality of life would lead to a less positive view. Screening may have effects on quality of life in the short run for women participating and effects in the long run as a result of the expected shift in the number of women experiencing early and advanced phases of the disease, after the initiation of the programme. In this study 4 steps have been taken: (I) published studies on quality of life and breast cancer (screening) up to 1989 have been reviewed and summarized and, based on these data, the consequences of breast cancer and treatment have been described; (2) values have been assigned to the disease and treatment phases by experts in breast cancer and public health (N = 31, response 87%); (3) these values have been inserted in the MISCAN model predicting the prevalence of disease/treatment phases with and without a 2-yearly screening programme for women aged 50-70 and multiplied by the duration of these phases; (4) analyses have been done to establish the sensitivity of the results for the values inserted. The programme of 2-yearly mammographic screening for women aged 50-70 is predicted to be 8% "less effective" (range -19.7 to +3.2%) when computing quality-adjusted life-years. We conclude that this adjustment is too small to attribute a major role to quality of life in the decision to undertake a large-scale breast cancer screening programme.

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

“…However, our sensitivity analysis showed that adjusting for quality of life has little impact on cost-effectiveness estimates, which is in line with earlier findings. 41,50 In addition, when we adjust for quality of life, the incremental cost-effectiveness ratios are slightly more favourable and therefore remain below the threshold of £20,000 per QALY gained (approximately e24,000 per QALY gained). When we compare the ICERs to the willingness-to-pay threshold of e20,000 per QALY gained, often cited in Dutch cost-effectiveness analyses, [51][52][53] all screening scenarios remain cost-effective.…”

“…3 The number of consultations after recall in the presence of screening is calculated by using the number of screen-detected cancers and a positive predictive value (PPV) of 30% 30 (ages 50-74) or 12% (ages [40][41][42][43][44][45][46][47][48][49]. The number of consultations after recall in the absence of screening is calculated by using the number of clinically detected cancers and a PPV of 58.3%.…”

“…We included reductions in utility associated with screening participation and a positive screen of 0.006 for 1 week and 0.105 for 5 weeks, respectively. 41 To take into account reductions in utility from breast cancer treatment, we used adjusted health utilities reported by Stout et al, 42 with minor adjustments in the application of these utilities as our model cannot discriminate between regional and distant breast cancer stages (Supporting Information Appendix, Table 1). Women who do not die of breast cancer were assumed to experience a loss in quality of life of 0.1 for 2 years from diagnosis if diagnosed with in situ or localised breast cancer and a loss of 0.25 for 2 years from diagnosis if diagnosed with regional or distant breast cancer.…”

Mammography Utilization, Public Health Impact, and Cost- Effectiveness in the United States

“…No studies were identified that reported costs per quality-adjusted year of life saved. It has recently been estimated that quality adjustment reduces the estimated effec tiveness of a breast cancer screening program by about 8%, which is considered too small an effect to influence decision-making (26). Studies were included in the review only if costs per year of life saved were reported; costs were defined to include screening costs, the costs associated with the diagnostic work-up of false-positives, and the savings in treatment costs; and both costs and benefits occurring in the future were discounted to reflect societal time preference .…”

Possible net harms of breast cancer screening: updated modelling of Forrest report

“…This is 17 The 2010 systematic review of the utility losses from breast cancer included estimates of this loss of between 11% and 34% 15 but warned that the studies could not be synthesised.…”