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PLoS One. 2014 Feb 3;9(2):e86858. doi: 10.1371/journal.pone.0086858. eCollection 2014.

Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer.

Author information

1
Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain ; Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain.
2
Economics Department and Research Centre on Industrial and Public Economics (CREIP), Rovira i Virgili University, Reus, Catalonia, Spain.
3
Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain ; Health Services Research Network in Chronic Diseases (REDISSEC), Spain.
4
Surgery Department, Rovira i Virgili University, Reus, Catalonia, Spain ; General and Digestive Surgery Department, Joan XXIII Teaching Hospital, Tarragona, Catalonia, Spain.
5
Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain.
6
Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain ; Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain ; Health Services Research Network in Chronic Diseases (REDISSEC), Spain.

Abstract

The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.

PMID:
24498285
PMCID:
PMC3911927
DOI:
10.1371/journal.pone.0086858
[Indexed for MEDLINE]
Free PMC Article

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