Format

Send to

Choose Destination
Soc Sci Med. 2019 May;228:142-154. doi: 10.1016/j.socscimed.2019.03.028. Epub 2019 Mar 21.

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

Author information

1
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Health Economics Unit, University of Birmingham, Birmingham, West Midlands, UK.
2
Centre for Health Economics, Monash University, Melbourne, Victoria, Australia.
3
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
4
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Research Division, Cancer Council NSW, Australia.
5
Cancer Research UK Clinical Trials Unit, University Hospital of Birmingham, Birmingham, West Midlands, UK.
6
Health Economics Unit, University of Birmingham, Birmingham, West Midlands, UK. Electronic address: T.E.ROBERTS@bham.ac.uk.

Abstract

Policy decisions regarding breast cancer screening and treatment programmes may be misplaced unless the decision process includes the appropriate utilities and disutilities of mammography screening and its sequelae. The objectives of this study were to critically review how economic evaluations have valued the health states associated with breast cancer screening, and appraise the primary evidence informing health state utility values (cardinal measures of quality of life). A systematic review was conducted up to September 2018 of studies that elicited or used utilities relevant to mammography screening. The methods used to elicit utilities and the quality of the reported values were tabulated and analysed narratively. 40 economic evaluations of breast cancer screening programmes and 10 primary studies measuring utilities for health states associated with mammography were reviewed in full. The economic evaluations made different assumptions about the measures used, duration applied and the sequalae included in each health state. 22 evaluations referenced utilities based on assumptions or used measures that were not methodologically appropriate. There was significant heterogeneity in the utilities generated by the 10 primary studies, including the methods and population used to derive them. No study asked women to explicitly consider the risk of overdiagnosis when valuing the health states described. Utilities informing breast screening policy are restricted in their ability to reflect the full benefits and harms. Evaluating the true cost-effectiveness of breast cancer screening will remain problematic, unless the methodological challenges associated with valuing the disutilities of screening are adequately addressed.

KEYWORDS:

Breast cancer; Health state utility value; Mammography; QALY; Quality of life; Screening

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center