Validation of a decision-analytic model for the cost-effectiveness analysis of a risk-stratified National Breast Screening Programme in the United Kingdom

Wright, Stuart; Gray, Ewan; Rogers, Gabriel; Donten, Anna; Payne, Katherine

doi:10.1101/2022.12.05.22283099

Cited by 2 publications

(13 citation statements)

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“…The validation of the model revealed some weaknesses in its ability to produce outputs that match those observed in reality 14 . While the distribution of stage of tumours identified at screening was similar in the model predictions and observed values, across all cancers the model tended to generate too many stage III cancers and too few at stage I.…”

Section: Discussionmentioning

confidence: 99%

“…An existing early model-based cost-effectiveness analysis, using the Gray-model, was updated to address the key criteria described in Table 1. The Gray-model underwent validation and modest amendments to its structure; for details, see Wright et al 14 .…”

Section: Methodsmentioning

confidence: 99%

“…The Gray-model code and the updated analysis were built in the R statistical package 17 . The updated Gray-model is called MANC-RISK-SCREEN and is available in a publicly available GitHub repository 18 . The reporting in this paper follows published criteria 19 .…”

Section: Methodsmentioning

confidence: 99%

“…The final chosen utility values were those from Naik et al (2017) comprising a utility value of 0.82 for cancer of stage I-III and 0.75 for stage IV cancers 48 . The full process for choosing these utility values is detailed in the "parameter update version 0 to 1" documentation file of the model GitHub repository 18 .…”

Section: Health Consequencesmentioning

confidence: 99%

“…In 2017, Gray and colleagues published an early decision-analytic model-based cost-effectiveness analysis focused on understanding the indicative healthcare costs and health consequences of exemplar stratified approaches for use in a NBSP 1 . Their model (hereafter ‘the Gray-model’), which includes a model of breast tumour growth, has subsequently undergone validation, including complete technical verification 14,15 . This study aimed to update the early analysis published by Gray and colleagues using the validated form of the decision-analytic model to identify and quantify the healthcare costs and health consequences of three exemplar risk-stratified-NBSP compared with the current NBSP (3-yearly screening), an NBSP with biennial screening (as is common in most European programmes), and no screening.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Risk-Stratified National Breast Screening Programme in the United Kingdom: An updated cost-effectiveness analysis

Wright,

Rogers,

Gray

et al. 2024

Preprint

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Study objectiveTo update a published early economic evaluation of exemplar risk-stratified national breast screening programmes (stratified-NBSP).MethodAn existing validated decision-analytic model, using discrete event simulation (the ‘Gray-model’), was used to structure the pathways for 3 stratified-NBSP (risk-1; risk-2; risk-3) compared with the current NBSP in the United Kingdom (UK-NBSP), biannual screening, and no screening. The updated model is called MANC-RISK-SCREEN and assumes a life-time horizon, the UK health service perspective to identify costs (using £; 2022) and measures health consequences using life-years and Quality Adjusted Life Years (QALYs). The original data sources used for the Gray-model were assessed for current relevance and updated where feasible. Updated data sources included: cancer and all-cause mortality; breast cancer incidence; breast cancer risk data; tumour staging; recall rate; mammographic sensitivity by breast density group; costs; and utilities. Model parameter uncertainty was assessed using Probabilistic Sensitivity Analysis (PSA) and one-way sensitivity analysis.ResultsThe base case analysis, supported by PSA, suggested that there was always a risk-stratified approach to breast cancer screening that was superior to universal screening. In the base case analysis, a strategy of dividing women into three equal groups based on risk was the most cost-effective. In the PSA, a strategy based on that used in the BC-PREDICT study was the most cost-effective. There was uncertainty in whether the addition of reduced screening for women at lower risk was cost-effective.ConclusionThe results of this study suggest that risk-stratified approaches to breast cancer screening are more cost-effective than both 3-yearly and 2-yearly universal screening.HighlightsA published early decision-analytic model-based cost-effectiveness analysis, using discrete event simulation (the ‘Gray model’), produced indicative results suggesting all included exemplars of a stratified national breast screening programme (stratified-NBSP) were cost-effective compared with no screening but a fully incremental analysis indicated only risk-based stratified-NBSP were cost-effective.This study uses a subsequently validated version of the Gray-model to produce a cost-effectiveness analysis with an updated model called MANC-RISK-SCREEN using revised descriptions of the relevant stratified-NBSP and new values for cancer and all-cause mortality; breast cancer incidence; breast cancer risk data; tumour staging; recall rate; mammographic sensitivity by breast density group; costs; and utilities.This analysis builds on the indicative estimates of the healthcare costs and health consequences of stratified-NBSP and suggests, with the current level of evidence, they are a cost-effective use of the NHS budget in the United Kingdom but uncertainty remains in the value of reducing screening for those at lower risk.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Health Consequencesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Risk-Stratified National Breast Screening Programme in the United Kingdom: An updated cost-effectiveness analysis

Wright,

Rogers,

Gray

et al. 2024

Preprint

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A structured process for the validation of a decision-analytic model: application to a cost-effectiveness model for risk-stratified national breast screening

Wright,

Gray,

Rogers

et al. 2024

Appl Health Econ Health Policy

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Background Decision-makers require knowledge of the strengths and weaknesses of decision-analytic models used to evaluate healthcare interventions to be able to confidently use the results of such models to inform policy. A number of aspects of model validity have previously been described, but no systematic approach to assessing the validity of a model has been proposed. This study aimed to consolidate the different aspects of model validity into a step-by-step approach to assessing the strengths and weaknesses of a decision-analytic model. Methods A pre-defined set of steps were used to conduct the validation process of an exemplar early decision-analytic-model-based cost-effectiveness analysis of a risk-stratified national breast cancer screening programme [UK healthcare perspective; lifetime horizon; costs (£; 2021)]. Internal validation was assessed in terms of descriptive validity, technical validity and face validity. External validation was assessed in terms of operational validation, convergent validity (or corroboration) and predictive validity. Results The results outline the findings of each step of internal and external validation of the early decision-analytic-model and present the validated model (called ‘MANC-RISK-SCREEN’). The positive aspects in terms of meeting internal validation requirements are shown together with the remaining limitations of MANC-RISK-SCREEN. Conclusion Following a transparent and structured validation process, MANC-RISK-SCREEN has been shown to have satisfactory internal and external validity for use in informing resource allocation decision-making. We suggest that MANC-RISK-SCREEN can be used to assess the cost-effectiveness of exemplars of risk-stratified national breast cancer screening programmes (NBSP) from the UK perspective. Implications A step-by-step process for conducting the validation of a decision-analytic model was developed for future use by health economists. Using this approach may help researchers to fully demonstrate the strengths and limitations of their model to decision-makers. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-024-00887-z.

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Validation of a decision-analytic model for the cost-effectiveness analysis of a risk-stratified National Breast Screening Programme in the United Kingdom

Cited by 2 publications

References 48 publications

Evaluation of a Risk-Stratified National Breast Screening Programme in the United Kingdom: An updated cost-effectiveness analysis

Evaluation of a Risk-Stratified National Breast Screening Programme in the United Kingdom: An updated cost-effectiveness analysis

A structured process for the validation of a decision-analytic model: application to a cost-effectiveness model for risk-stratified national breast screening

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