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Tollens F, Baltzer PA, Froelich MF, Kaiser CG. Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses. Front Oncol 2023; 13:1292268. [PMID: 38130995 PMCID: PMC10733447 DOI: 10.3389/fonc.2023.1292268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Economic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening. Purpose To introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening. Materials and methods The various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed. Results Despite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes. Conclusion Economic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.
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Affiliation(s)
- Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal A.T. Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Clemens G. Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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2
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Raman S, Shafie AA, Tan BY, Abraham MT, Chen Kiong S, Cheong SC. Economic Evaluation of Oral Cancer Screening Programs: Review of Outcomes and Study Designs. Healthcare (Basel) 2023; 11:healthcare11081198. [PMID: 37108032 PMCID: PMC10138408 DOI: 10.3390/healthcare11081198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
A lack of guidance on economic evaluations for oral cancer screening programs forms a challenge for policymakers and researchers to fill the knowledge gap on their cost-effectiveness. This systematic review thus aims to compare the outcomes and design of such evaluations. A search for economic evaluations of oral cancer screening was performed on Medline, CINAHL, Cochrane, PubMed, health technology assessment databases, and EBSCO Open Dissertations. The quality of studies was appraised using QHES and the Philips Checklist. Data abstraction was based on reported outcomes and study design characteristics. Of the 362 studies identified, 28 were evaluated for eligibility. The final six studies reviewed consisted of modeling approaches (n = 4), a randomized controlled trial (n = 1), and a retrospective observational study (n = 1). Screening initiatives were mostly shown to be cost-effective compared to non-screening. However, inter-study comparisons remained ambiguous due to large variations. The observational and randomized controlled trials provided considerably accurate evidence of implementation costs and outcomes. Modeling approaches, conversely, appeared more feasible for the estimation of long-term consequences and the exploration of strategy options. The current evidence of the cost-effectiveness of oral cancer screening remains heterogeneous and inadequate to support its institutionalization. Nevertheless, evaluations incorporating modeling methods may provide a practical and robust solution.
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Affiliation(s)
- Sivaraj Raman
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Shah Alam 40170, Malaysia
| | - Asrul Akmal Shafie
- Institutional Planning and Strategic Center, Universiti Sains Malaysia, Penang 11800, Malaysia
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Bee Ying Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Mannil Thomas Abraham
- Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah, Ministry of Health, Klang 41200, Malaysia
| | - Shim Chen Kiong
- Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak, Ministry of Health, Kuching 93586, Malaysia
| | - Sok Ching Cheong
- Digital Health Research Unit, Cancer Research Malaysia, Subang Jaya 47500, Malaysia
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
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3
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Kepesidis KV, Bozic-Iven M, Huber M, Abdel-Aziz N, Kullab S, Abdelwarith A, Al Diab A, Al Ghamdi M, Hilal MA, Bahadoor MRK, Sharma A, Dabouz F, Arafah M, Azzeer AM, Krausz F, Alsaleh K, Zigman M, Nabholtz JM. Breast-cancer detection using blood-based infrared molecular fingerprints. BMC Cancer 2021; 21:1287. [PMID: 34856945 PMCID: PMC8638519 DOI: 10.1186/s12885-021-09017-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer screening is currently predominantly based on mammography, tainted with the occurrence of both false positivity and false negativity, urging for innovative strategies, as effective detection of early-stage breast cancer bears the potential to reduce mortality. Here we report the results of a prospective pilot study on breast cancer detection using blood plasma analyzed by Fourier-transform infrared (FTIR) spectroscopy - a rapid, cost-effective technique with minimal sample volume requirements and potential to aid biomedical diagnostics. FTIR has the capacity to probe health phenotypes via the investigation of the full repertoire of molecular species within a sample at once, within a single measurement in a high-throughput manner. In this study, we take advantage of cross-molecular fingerprinting to probe for breast cancer detection. METHODS We compare two groups: 26 patients diagnosed with breast cancer to a same-sized group of age-matched healthy, asymptomatic female participants. Training with support-vector machines (SVM), we derive classification models that we test in a repeated 10-fold cross-validation over 10 times. In addition, we investigate spectral information responsible for BC identification using statistical significance testing. RESULTS Our models to detect breast cancer achieve an average overall performance of 0.79 in terms of area under the curve (AUC) of the receiver operating characteristic (ROC). In addition, we uncover a relationship between the effect size of the measured infrared fingerprints and the tumor progression. CONCLUSION This pilot study provides the foundation for further extending and evaluating blood-based infrared probing approach as a possible cross-molecular fingerprinting modality to tackle breast cancer detection and thus possibly contribute to the future of cancer screening.
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Affiliation(s)
- Kosmas V Kepesidis
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany.
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany.
| | - Masa Bozic-Iven
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
| | - Marinus Huber
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany
| | - Nashwa Abdel-Aziz
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Sharif Kullab
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Ahmed Abdelwarith
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | | | - Mohammed Al Ghamdi
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Muath Abu Hilal
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Mohun R K Bahadoor
- Clinical Operations, International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Abhishake Sharma
- Clinical Operations, International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Farida Dabouz
- Clinical Operations, International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Maria Arafah
- Pathology Department, King Saud University, Riyadh, Saudi Arabia
| | - Abdallah M Azzeer
- Physics and Astronomy Department, Attosecond Science Laboratory, King Saud University, Riyadh, Saudi Arabia
| | - Ferenc Krausz
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany
| | - Khalid Alsaleh
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Mihaela Zigman
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany
| | - Jean-Marc Nabholtz
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
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5
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Mühlberger N, Sroczynski G, Gogollari A, Jahn B, Pashayan N, Steyerberg E, Widschwendter M, Siebert U. Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1311-1344. [PMID: 34342797 DOI: 10.1007/s10198-021-01338-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. METHODS Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. RESULTS Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. CONCLUSIONS Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.
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Affiliation(s)
- Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Artemisa Gogollari
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Nora Pashayan
- Institute of Epidemiology and Healthcare, Department of Applied Health Research, UCL-University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, PO Box 9600, 3000 CA, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Widschwendter
- Department of Women's Cancer, EGA Institute for Women's Health, UCL - University College London, 74 Huntley St, Rm 340, London, WC1E 6AU, UK
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
- Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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6
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Lin CN, Lee KT, Chang SM, Wang JD. Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data. J Formos Med Assoc 2021; 121:633-642. [PMID: 34246512 DOI: 10.1016/j.jfma.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. METHODS We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. RESULTS The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. CONCLUSION Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.
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Affiliation(s)
- Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Ting Lee
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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7
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Zoratti MJ, Pickard AS, Stalmeier PFM, Ollendorf D, Lloyd A, Chan KKW, Husereau D, Brazier JE, Krahn M, Levine M, Thabane L, Xie F. Evaluating the conduct and application of health utility studies: a review of critical appraisal tools and reporting checklists. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:723-733. [PMID: 33839968 DOI: 10.1007/s10198-021-01286-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/12/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Published health utility studies are increasingly cited in cost-utility analyses to inform reimbursement decision-making. However, there is limited guidance for investigators looking to systematically evaluate the methodological quality of health utility studies or their applicability to decision contexts. OBJECTIVE To describe how health utility concepts are reflected in tools intended for use with the health economic literature, particularly with respect to the evaluation of methodological quality and context applicability. METHODS We reviewed the critical appraisal and reporting tools described in a 2012 report published by the Agency for Healthcare Research and Quality (AHRQ), supplemented with a keyword search of MEDLINE and EMBASE, to identify existing tools which include health utility constructs. From these tools, a list of relevant items was compiled and grouped into domain categories based on the methodological or applicability aspect they were directed toward. RESULTS Of the 24 tools we identified, 12 contained items relevant to the evaluation of health utilities. Sixty-five items were considered relevant to the evaluation of quality, while 44 were relevant to the evaluation of applicability. Items were arranged into four domains: health state descriptions; selection and description of respondents; elicitation and measurement methods; and other considerations. CONCLUSION As key inputs to cost-utility analyses, health utilities have the potential to significantly impact estimates of cost-effectiveness. Existing tools contain only general items related to the conduct or use of health utility studies. There is a need to develop tools that systematically evaluate the methodological quality and applicability of health utility studies.
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Affiliation(s)
- Michael J Zoratti
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, The University of Illinois at Chicago, Chicago, IL, USA
| | - Peep F M Stalmeier
- Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Daniel Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Kelvin K W Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John E Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Murray Krahn
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Mitchell Levine
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- St Joseph's Healthcare, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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Corro Ramos I, Hoogendoorn M, Rutten-van Mölken MPMH. How to Address Uncertainty in Health Economic Discrete-Event Simulation Models: An Illustration for Chronic Obstructive Pulmonary Disease. Med Decis Making 2020; 40:619-632. [PMID: 32608322 PMCID: PMC7401182 DOI: 10.1177/0272989x20932145] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
Background. Evaluation of personalized treatment options requires health economic models that include multiple patient characteristics. Patient-level discrete-event simulation (DES) models are deemed appropriate because of their ability to simulate a variety of characteristics and treatment pathways. However, DES models are scarce in the literature, and details about their methods are often missing. Methods. We describe 4 challenges associated with modeling heterogeneity and structural, stochastic, and parameter uncertainty that can be encountered during the development of DES models. We explain why these are important and how to correctly implement them. To illustrate the impact of the modeling choices discussed, we use (results of) a model for chronic obstructive pulmonary disease (COPD) as a case study. Results. The results from the case study showed that, under a correct implementation of the uncertainty in the model, a hypothetical intervention can be deemed as cost-effective. The consequences of incorrect modeling uncertainty included an increase in the incremental cost-effectiveness ratio ranging from 50% to almost a factor of 14, an extended life expectancy of approximately 1.4 years, and an enormously increased uncertainty around the model outcomes. Thus, modeling uncertainty incorrectly can have substantial implications for decision making. Conclusions. This article provides guidance on the implementation of uncertainty in DES models and improves the transparency of reporting uncertainty methods. The COPD case study illustrates the issues described in the article and helps understanding them better. The model R code shows how the uncertainty was implemented. For readers not familiar with R, the model's pseudo-code can be used to understand how the model works. By doing this, we can help other developers, who are likely to face similar challenges to those described here.
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Affiliation(s)
- Isaac Corro Ramos
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Maureen P. M. H. Rutten-van Mölken
- />Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- />Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
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9
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Smith H, Varshoei P, Boushey R, Kuziemsky C. Use of Simulation Modeling to Inform Decision Making for Health Care Systems and Policy in Colorectal Cancer Screening: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16103. [PMID: 32401223 PMCID: PMC7254289 DOI: 10.2196/16103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/09/2019] [Accepted: 11/26/2019] [Indexed: 01/15/2023] Open
Abstract
Background Simulation modeling has frequently been used to assess interventions in complex aspects of health care, such as colorectal cancer (CRC) screening, where clinical trials are not feasible. Simulation models provide estimates of outcomes, unintended consequences, and costs of an intervention; thus offering an invaluable decision aid for policy makers and health care leaders. However, the contribution that simulation models have made to policy and health system decisions is unknown. Objective This study aims to assess if simulation modeling has supported evidence-informed decision making in CRC screening. Methods A preliminary literature search and pilot screening of 100 references were conducted by three independent reviewers to define and refine the inclusion criteria of this systematic review. Using the developed inclusion criteria, a search of the academic and gray literature published between January 1, 2008, and March 1, 2019, will be conducted to identify studies that developed a simulation model focusing on the delivery of CRC screening of average-risk individuals. The three independent reviewers will assess the validation process and the extent to which the study contributed evidence toward informed decision making (both reported and potential). Validation will be assessed based on adherence to the best practice recommendations described by the International Society for Pharmacoeconomics and Outcomes Research-Society for Medical Decision Making (ISPOR-SMDM). Criteria for potential contribution to decision making will be defined as outlined in the internationally recognized Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision (GRADE EtD) framework. These criteria outline information that the health system and policy decision makers should consider when making an evidence-informed decision including an intervention’s resource utilization, cost-effectiveness, impact on health equity, and feasibility. Subgroup analysis of articles based on their GRADE EtD criteria will be conducted to identify methods associated with decision support capacity (ie, participatory, quantitative, or mixed methods). Results A database search of the literature yielded 484 references to screen for inclusion in the systematic review. We anticipate that this systematic review will provide an insight into the contribution of simulation modeling methods to informed decision making in CRC screening delivery and discuss methods that may be associated with a stronger impact on decision making. The project was funded in May 2019. Data collection took place from January 2008 to March 2019. Data analysis was completed in November 2019, and are expected to be published in spring 2020. Conclusions Our findings will help guide researchers and health care leaders to mobilize the potential for simulation modeling to inform evidence-informed decisions in CRC screening delivery. The methods of this study may also be replicated to assess the utility of simulation modeling in other areas of complex health care decision making. International Registered Report Identifier (IRRID) DERR1-10.2196/16103 Trial Registration PROSPERO no. 130823; https://www.crd.york.ac.uk/PROSPERO
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Affiliation(s)
- Heather Smith
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Peyman Varshoei
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Robin Boushey
- Division of Colorectal Surgery, The Ottawa Hospital, Department of Surgery, Ottawa, ON, Canada
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, AB, Canada
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10
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Yuniar P, Robinson S, Moorin R, Norman R. Economic Evaluation of Breast Cancer Early Detection Strategies in Asia: A Systematic Review. Value Health Reg Issues 2020; 21:252-263. [PMID: 32388197 DOI: 10.1016/j.vhri.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/01/2019] [Accepted: 01/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This article aims to support the development of practical guidelines for early detection of breast cancer in Asia by systematically reviewing economic evaluation studies of such early detection strategies in Asian countries. METHODS A systematic literature review was conducted following the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. The quality of reviewed studies was examined using the Consolidated Health Economic Evaluation Reporting Standards statement. RESULTS A total of 15 articles on the economic evaluation of breast cancer early detection based in Asia were reviewed. Cost-effectiveness was used in all the studies as the analytic method to compare the cost and consequences of different screening policies. Ten studies were categorized as incorporating the modeled approach. Fourteen studies analysed the cost-effectiveness of the organized population-based approach, in which mammography screening was the prevailing screening modality. Only one study evaluated the cost-effectiveness of early diagnosis for breast cancer patients in order to provide early treatment. The results from the identified economic evaluations, and consequent recommendations concerning optimal early detection strategies varied among studies, and depended on key parameters and assumption used, as well as differences in inter-country health resources, breast cancer incidence, prevalence and early detection pathways. CONCLUSIONS The economic evaluation of breast cancer early detection programs is still limited in Asia. Policy decisions on organized mammography screening in women <50 are economically attractive in the region, despite the lack of evidence to provide recommendations on opportunistic screening strategy and early diagnosis strategy. Future studies need to provide better transparency of the data used and cover more comprehensive strategies, to make them relevant and adaptable to other Asian countries, resulting in clear policy recommendations on breast cancer early detection strategies.
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Affiliation(s)
- Popy Yuniar
- School of Public Health, Curtin University, Perth, Western Australia; Universitas Indonesia, West Java, Indonesia.
| | - Suzanne Robinson
- School of Public Health, Curtin University, Perth, Western Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia
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Mandrik O, Zielonke N, Meheus F, Severens J(H, Guha N, Herrero Acosta R, Murillo R. Systematic reviews as a 'lens of evidence': Determinants of benefits and harms of breast cancer screening. Int J Cancer 2019; 145:994-1006. [PMID: 30762235 PMCID: PMC6619055 DOI: 10.1002/ijc.32211] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15-25% in trials and 28-56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1-60% in trials and 1-12% in studies with a low risk of bias, and cumulative false-positive rates were lower with biennial than annual screening (3-17% vs 0.01-41%). There is no consistency in the reviews' conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen-film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54-84% and 47-69%, respectively), and strong evidence of unfavourable benefit-to-harm ratio with breast self-examination. The reviews' conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high-income countries, systematically disagree on the interpretation of the benefit-to-harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.
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Affiliation(s)
- Olena Mandrik
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
- Erasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
- Health Economic and Decision Science (HEDS), School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUnited Kingdom
| | - Nadine Zielonke
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Filip Meheus
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
| | - J.L. (Hans) Severens
- Erasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
- Institute for Medical Technology Assessment (iMTA)Erasmus University RotterdamRotterdamThe Netherlands
| | - Neela Guha
- Section of Evidence Synthesis and ClassificationInternational Agency for Research on CancerLyonFrance
| | - Rolando Herrero Acosta
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
| | - Raul Murillo
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
- Centro Javeriano de Oncología – Hospital Universitario San IgnacioBogotáColombia
- Faculty of Medicine – Pontificia Universidad JaverianaBogotáColombia
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Li L, Severens JL(H, Mandrik O. Disutility associated with cancer screening programs: A systematic review. PLoS One 2019; 14:e0220148. [PMID: 31339958 PMCID: PMC6655768 DOI: 10.1371/journal.pone.0220148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Disutility allows to identify how much population values intervention-related harms contributing to knowledge on the benefits/harms ratio of cancer screening programs. This systematic review evaluates disutility related to cancer screening applying a utility theory framework. METHODS Using a predefined protocol, Embase, Medline Ovid, Web of Science, Cochrane, Google scholar and supplementary sources were systematically searched. The framework grouped disutilities associated with breast, cervical, lung, colorectal, and prostate cancer screening programs into the screening, diagnostic work up, and treatment phases. We assessed the quality of included studies according to the relevance to target population, risk of bias, appropriateness of measure and the time frame. RESULTS Out of 2840 hits, we included 38 studies, of which 27 measured (and others estimated) disutilities. Around 70% of studies had medium to high-level quality. Measured disutilities and Quality Adjusted Life Years loss were 0-0.03 and 0-0.0013 respectively in screening phases. Both disutilities and Quality Adjusted Life Years loss had similar ranges in diagnostic work up (0-0.26), and treatment (0.09-0.27) phases. We found no measured disutilities available for lung cancer screening and-little evidence for disutilities in treatment phase. Almost 40% of the estimated disutility values were above the range of measured ones. CONCLUSIONS Cancer screening programs led to low disutities related to screening phase, and low to moderate disutilities related to diagnostic work up and treatment phases. These disutility values varied by the measurement instrument applied, and were higher in studies with lower quality. The estimated disutility values comparing to the measured ones tended to overestimate the harms.
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Affiliation(s)
- Lin Li
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - J. L. (Hans) Severens
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Olena Mandrik
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- The University of Sheffield, School of Health and Related Research (ScHARR), Health Economic and Decision Science (HEDS), Sheffield, United Kingdom
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Krebs E, Enns B, Wang L, Zang X, Panagiotoglou D, Del Rio C, Dombrowski J, Feaster DJ, Golden M, Granich R, Marshall B, Mehta SH, Metsch L, Schackman BR, Strathdee SA, Nosyk B. Developing a dynamic HIV transmission model for 6 U.S. cities: An evidence synthesis. PLoS One 2019; 14:e0217559. [PMID: 31145752 PMCID: PMC6542533 DOI: 10.1371/journal.pone.0217559] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dynamic HIV transmission models can provide evidence-based guidance on optimal combination implementation strategies to treat and prevent HIV/AIDS. However, these models can be extremely data intensive, and the availability of good-quality data characterizing regional microepidemics varies substantially within and across countries. We aim to provide a comprehensive and transparent description of an evidence synthesis process and reporting framework employed to populate and calibrate a dynamic, compartmental HIV transmission model for six US cities. METHODS We executed a mixed-method evidence synthesis strategy to populate model parameters in six categories: (i) initial HIV-negative and HIV-infected populations; (ii) parameters used to calculate the probability of HIV transmission; (iii) screening, diagnosis, treatment and HIV disease progression; (iv) HIV prevention programs; (v) the costs of medical care; and (vi) health utility weights for each stage of HIV disease progression. We identified parameters that required city-specific data and stratification by gender, risk group and race/ethnicity a priori and sought out databases for primary analysis to augment our evidence synthesis. We ranked the quality of each parameter using context- and domain-specific criteria and verified sources and assumptions with our scientific advisory committee. FINDINGS To inform the 1,667 parameters needed to populate our model, we synthesized evidence from 59 peer-reviewed publications and 24 public health and surveillance reports and executed primary analyses using 11 data sets. Of these 1,667 parameters, 1,517 (91%) were city-specific and 150 (9%) were common for all cities. Notably, 1,074 (64%), 201 (12%) and 312 (19%) parameters corresponded to categories (i), (ii) and (iii), respectively. Parameters ranked as best- to moderate-quality evidence comprised 39% of the common parameters and ranged from 56%-60% across cities for the city-specific parameters. We identified variation in parameter values across cities as well as within cities across risk and race/ethnic groups. CONCLUSIONS Better integration of modelling in decision making can be achieved by systematically reporting on the evidence synthesis process that is used to populate models, and by explicitly assessing the quality of data entered into the model. The effective communication of this process can help prioritize data collection of the most informative components of local HIV prevention and care services in order to reduce decision uncertainty and strengthen model conclusions.
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Affiliation(s)
- Emanuel Krebs
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Benjamin Enns
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Linwei Wang
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Xiao Zang
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Dimitra Panagiotoglou
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Carlos Del Rio
- Hubert Department of Global Health, Emory Center for AIDS Research, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Julia Dombrowski
- Department of Medicine, Division of Allergy & Infectious Disease, adjunct in Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Daniel J. Feaster
- Center for Family Studies, Department of Epidemiology and Public Health, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Matthew Golden
- Department of Medicine, Division of Allergy & Infectious Disease, adjunct in Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Reuben Granich
- International Association of Providers of AIDS Care, Washington, DC, United States of America
| | - Brandon Marshall
- Department of Epidemiology, Brown School of Public Health, Providence, RI, United States of America
| | - Shruti H. Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Bruce R. Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States of America
| | - Steffanie A. Strathdee
- School of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Bohdan Nosyk
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Bromley HL, Petrie D, Mann GB, Nickson C, Rea D, Roberts TE. Valuing the health states associated with breast cancer screening programmes: A systematic review of economic measures. Soc Sci Med 2019; 228:142-154. [PMID: 30913528 DOI: 10.1016/j.socscimed.2019.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/21/2019] [Accepted: 03/15/2019] [Indexed: 12/26/2022]
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.
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Affiliation(s)
- Hannah L Bromley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Health Economics Unit, University of Birmingham, Birmingham, West Midlands, UK
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Carolyn Nickson
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Research Division, Cancer Council NSW, Australia
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit, University Hospital of Birmingham, Birmingham, West Midlands, UK
| | - Tracy E Roberts
- Health Economics Unit, University of Birmingham, Birmingham, West Midlands, UK.
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Health-related quality of life and utility scores of patients with breast neoplasms in China: A multicenter cross-sectional survey. Breast 2018; 39:53-62. [PMID: 29597131 DOI: 10.1016/j.breast.2018.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/07/2018] [Accepted: 03/12/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Health-related quality of life and utility scores of patients with breast cancer and precancerous lesions are sparse in China. This study aimed to derive utility scores of patients with breast cancer and precancer in China. MATERIAL AND METHODS An interviewer-administered cross-sectional survey was conducted in 12 provinces across China from 2013 to 2014. The three-level EuroQol-5-Dimension instrument was used to evaluate quality of life, and utility scores were generated using the Chinese value set. Univariate and multivariate analyses were performed to explore the determinants of utility scores. RESULTS In total, 2626 breast cancer and 471 precancer patients were included. Mean age was 49.1 for breast cancer and 41.4 years for precancer (p < 0.001). Among the five dimensions, pain/discomfort was the most reported problem, 53.9% in breast cancer and 29.3% in precancer patients. Mean (95% CI) utility scores for breast cancer and precancer patients were estimated as 0.887 (0.875-0.899) and 0.781 (0.774-0.788), and the scores of breast cancer at stage-I, stage-II, stage-III and stage-IV were 0.789 (0.774-0.805), 0.793 (0.783-0.802), 0.774 (0.759-0.788) and 0.686 (0.654-0.717), respectively. Mean (95% CI) visual analogue scale scores for breast cancer and precancer were 75.6 (74.0-77.3) and 72.8 (72.3-73.3). Multiple regression showed advanced clinical stage, lower educational level, lower household income, surgery treatment, and undergoing treatment were independently associated with lower utility scores for breast cancer patients. CONCLUSION The utility scores deteriorate with the severity of breast neoplasms. Detailed utility scores of breast cancer and precancer are fundamental for further cost-utility analysis in China.
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Arnold M. Simulation modeling for stratified breast cancer screening - a systematic review of cost and quality of life assumptions. BMC Health Serv Res 2017; 17:802. [PMID: 29197417 PMCID: PMC5712150 DOI: 10.1186/s12913-017-2766-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care. METHODS A literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters. RESULTS Eighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias. CONCLUSION This systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters.
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Affiliation(s)
- Matthias Arnold
- Munich Center of Health Sciences, LMU, Munich, Germany. .,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany. .,Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Ludwig-Maximilians-Universität München, Ludwigstr. 28 RG, 5. OG, 80539, Munich, Germany.
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Schiller-Fruehwirth I, Jahn B, Einzinger P, Zauner G, Urach C, Siebert U. The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1048-1057. [PMID: 28964436 DOI: 10.1016/j.jval.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 04/02/2017] [Accepted: 04/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. OBJECTIVES To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. METHODS We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. RESULTS Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. CONCLUSIONS The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria.
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Affiliation(s)
- Irmgard Schiller-Fruehwirth
- Department of Evidence-Based Economic Health Care, Main Association of Austrian Social Security Institutions, Vienna, Austria; Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Beate Jahn
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Patrick Einzinger
- dwh Simulation Services, Vienna, Austria; Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria
| | | | | | - Uwe Siebert
- Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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