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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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Saxby K, Nickson C, Mann GB, Park A, Bromley H, Velentzis L, Procopio P, Canfell K, Petrie D. Moving beyond the stage: how characteristics at diagnosis dictate treatment and treatment-related quality of life year losses for women with early stage invasive breast cancer. Expert Rev Pharmacoecon Outcomes Res 2020; 21:847-857. [PMID: 33253057 DOI: 10.1080/14737167.2021.1857735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:Although evaluations of breast cancer screening programs frequently estimate quality-adjusted life-year (QALY) losses by stage, other breast cancer characteristics influence treatment and vary by mode of detection - i.e. whether the cancer is detected through screening (screen-detected), between screening rounds (interval-detected) or outside screening (community-detected). Here, we estimate the association between early-stage invasive breast cancer (ESIBC) characteristics and treatment-related QALY losses.Methods:Using clinicopathological and treatment information from 675 women managed for ESIBC, we estimated the average five-year treatment-related QALY loss by detection group. We then used regression analysis to estimate the extent to which known cancer characteristics and the detection mode, are associated with treatment and treatment-related QALY losses.Results:Community-detected cancers had the largest QALY loss (0.76 QALYs [95% CI 0.73;0.80]), followed by interval-detected cancers (0.75 QALYs [95% CI 0.68;0.82]) and screen-detected cancers (0.69 QALYs [95%CI 0.67;0.71]). Adverse prognostic factors more common in community-detected and interval-detected breast cancers (large tumours, lymph node involvement, high grade) were largely associated with QALY losses from mastectomies and chemotherapy. Receptor-positive subtypes, more common in screen-detected cancers, were associated with QALY losses related to endocrine therapy.Conclusions:The associations between ESIBC characteristics and treatment-related QALY losses should be considered when evaluating breast cancer screening and treatment strategies.
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Affiliation(s)
- Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, VIC, Australia
| | - Carolyn Nickson
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.,Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia.,Sydney School of Public Health, Fisher Rd, The University of Sydney, Camperdown,NSW, Australia
| | - G Bruce Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Allan Park
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Hannah Bromley
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.,Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Louiza Velentzis
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.,Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia.,Sydney School of Public Health, Fisher Rd, The University of Sydney, Camperdown,NSW, Australia
| | - Pietro Procopio
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.,Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia.,Sydney School of Public Health, Fisher Rd, The University of Sydney, Camperdown,NSW, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, VIC, Australia
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3
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The Structure and Parameterization of the Breast Cancer Transition Model Among Chinese Women. Value Health Reg Issues 2019; 21:29-38. [PMID: 31634794 DOI: 10.1016/j.vhri.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Markov model simulation based on the natural history of disease is commonly employed for the comparative research of health interventions. The present study aims to simulate the natural progression of breast cancer and parameterize the initial and transition probabilities of multiple states of breast cancer development among Chinese women. METHODS The age-specific incidence, mortality, and clinical stage distribution of breast cancer; and relapse rate of each clinical stage were collected from China's cancer registry yearbooks and clinical epidemiological studies to simulate the process from full health to breast cancer to death among Chinese women aged 30 to 80 through a Markov cohort study. The validity analysis was conducted to evaluate the accuracy of the model estimation. RESULTS A Markov transition model with 7 states (no breast cancer, clinical stages 0-IV breast cancer, and death) was constructed for Chinese women. The age-specific incidence, mortality, and clinical stage distribution of breast cancer estimated by the initial and transition probabilities among different Markov states were highly consistent with the registered data and observed studies. CONCLUSION A breast cancer transition model for Chinese women has been established with validity. It could be a point of reference for further economic evaluations and breast cancer screening policy formulation.
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Schiller-Frühwirth IC, Jahn B, Arvandi M, Siebert U. Cost-Effectiveness Models in Breast Cancer Screening in the General Population: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:333-351. [PMID: 28185134 DOI: 10.1007/s40258-017-0312-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many Western countries have long-established population-based mammography screening programs. Prior to implementing these programs, decision-analytic modeling was widely used to inform decisions. OBJECTIVE The aim of this study was to perform a systematic review of cost-effectiveness models in breast cancer screening in the general population to analyze their structural and methodological approaches. METHODS A systematic literature search for health economic models was performed in the electronic databases MEDLINE (Ovid), EMBASE, CRD Databases, Cochrane Library, and EconLit in August 2011 with updates in June 2013, April 2015, and November 2016. To assess studies systematically, a standardized form was applied to extract relevant information that was then summarized in evidence tables. RESULTS Thirty-five studies were included; 27 state-transition models were analyzed using cohort (n = 12) and individual-level simulation (n = 15). Twenty-one studies modeled the natural history of breast cancer and predicted mortality as a function of the early detection modality. The models employed different assumptions regarding ductal carcinoma in situ. Thirteen studies performed cost-utility analyses with different sources for utility values, but assumptions were often made about utility weights. Twenty-two models did not report any validation. CONCLUSION State-transition modeling was the most frequently applied analytic approach. Different methods in modeling the progression of ductal carcinoma in situ to invasive cancer were identified because there is currently no agreement on the biological behavior of noninvasive breast cancer. Main weaknesses were the lack of precise utility estimates and insufficient reporting of validation. Sensitivity analyses of assumptions regarding ductal carcinoma in situ and in particular adequate validation are critical to minimize the risk of biased model outcomes.
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Affiliation(s)
- Irmgard C Schiller-Frühwirth
- Department of Evidence-Based Economic Health Care, Main Association of Austrian Social Security Institutions, Kundmanngasse 21, 1030, Vienna, Austria.
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, 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
| | - Marjan Arvandi
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, 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
- Department of Radiology, Institute for Technology Assessment, 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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Evans DG, Astley S, Stavrinos P, Harkness E, Donnelly LS, Dawe S, Jacob I, Harvie M, Cuzick J, Brentnall A, Wilson M, Harrison F, Payne K, Howell A. Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04110] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BackgroundIn the UK, women are invited for 3-yearly mammography screening, through the NHS Breast Screening Programme (NHSBSP), from the ages of 47–50 years to the ages of 69–73 years. Women with family histories of breast cancer can, from the age of 40 years, obtain enhanced surveillance and, in exceptionally high-risk cases, magnetic resonance imaging. However, no NHSBSP risk assessment is undertaken. Risk prediction models are able to categorise women by risk using known risk factors, although accurate individual risk prediction remains elusive. The identification of mammographic breast density (MD) and common genetic risk variants [single nucleotide polymorphisms (SNPs)] has presaged the improved precision of risk models.ObjectivesTo (1) identify the best performing model to assess breast cancer risk in family history clinic (FHC) and population settings; (2) use information from MD/SNPs to improve risk prediction; (3) assess the acceptability and feasibility of offering risk assessment in the NHSBSP; and (4) identify the incremental costs and benefits of risk stratified screening in a preliminary cost-effectiveness analysis.DesignTwo cohort studies assessing breast cancer incidence.SettingHigh-risk FHC and the NHSBSP Greater Manchester, UK.ParticipantsA total of 10,000 women aged 20–79 years [Family History Risk Study (FH-Risk); UK Clinical Research Network identification number (UKCRN-ID) 8611] and 53,000 women from the NHSBSP [aged 46–73 years; Predicting the Risk of Cancer At Screening (PROCAS) study; UKCRN-ID 8080].InterventionsQuestionnaires collected standard risk information, and mammograms were assessed for breast density by a number of techniques. All FH-Risk and 10,000 PROCAS participants participated in deoxyribonucleic acid (DNA) studies. The risk prediction models Manual method, Tyrer–Cuzick (TC), BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) and Gail were used to assess risk, with modelling based on MD and SNPs. A preliminary model-based cost-effectiveness analysis of risk stratified screening was conducted.Main outcome measuresBreast cancer incidence.Data sourcesThe NHSBSP; cancer registration.ResultsA total of 446 women developed incident breast cancers in FH-Risk in 97,958 years of follow-up. All risk models accurately stratified women into risk categories. TC had better risk precision than Gail, and BOADICEA accurately predicted risk in the 6268 single probands. The Manual model was also accurate in the whole cohort. In PROCAS, TC had better risk precision than Gail [area under the curve (AUC) 0.58 vs. 0.54], identifying 547 prospective breast cancers. The addition of SNPs in the FH-Risk case–control study improved risk precision but was not useful inBRCA1(breast cancer 1 gene) families. Risk modelling of SNPs in PROCAS showed an incremental improvement from using SNP18 used in PROCAS to SNP67. MD measured by visual assessment score provided better risk stratification than automatic measures, despite wide intra- and inter-reader variability. Using a MD-adjusted TC model in PROCAS improved risk stratification (AUC = 0.6) and identified significantly higher rates (4.7 per 10,000 vs. 1.3 per 10,000;p < 0.001) of high-stage cancers in women with above-average breast cancer risks. It is not possible to provide estimates of the incremental costs and benefits of risk stratified screening because of lack of data inputs for key parameters in the model-based cost-effectiveness analysis.ConclusionsRisk precision can be improved by using DNA and MD, and can potentially be used to stratify NHSBSP screening. It may also identify those at greater risk of high-stage cancers for enhanced screening. The cost-effectiveness of risk stratified screening is currently associated with extensive uncertainty. Additional research is needed to identify data needed for key inputs into model-based cost-effectiveness analyses to identify the impact on health-care resource use and patient benefits.Future workA pilot of real-time NHSBSP risk prediction to identify women for chemoprevention and enhanced screening is required.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. The DNA saliva collection for SNP analysis for PROCAS was funded by the Genesis Breast Cancer Prevention Appeal.
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Affiliation(s)
- D Gareth Evans
- Department of Genomic Medicine, Institute of Human Development, Manchester Academic Health Science Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Susan Astley
- Institute of Population Health, Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Paula Stavrinos
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Elaine Harkness
- Institute of Population Health, Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Louise S Donnelly
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Sarah Dawe
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Ian Jacob
- Department of Health Economics, University of Manchester, Manchester, UK
| | - Michelle Harvie
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Adam Brentnall
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Mary Wilson
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | | | - Katherine Payne
- Department of Health Economics, University of Manchester, Manchester, UK
| | - Anthony Howell
- Institute of Population Health, Centre for Imaging Sciences, University of Manchester, Manchester, UK
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
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Ngeow J, Liu C, Zhou K, Frick KD, Matchar DB, Eng C. Detecting Germline PTEN Mutations Among At-Risk Patients With Cancer: An Age- and Sex-Specific Cost-Effectiveness Analysis. J Clin Oncol 2015; 33:2537-44. [PMID: 26169622 DOI: 10.1200/jco.2014.60.3456] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumors. One-quarter of patients who are diagnosed with CS have pathogenic germline PTEN mutations, which increase the risk of the development of breast, thyroid, uterine, renal, and other cancers. PTEN testing and regular, intensive cancer surveillance allow for early detection and treatment of these cancers for mutation-positive patients and their relatives. Individual CS-related features, however, occur commonly in the general population, making it challenging for clinicians to identify CS-like patients to offer PTEN testing. PATIENTS AND METHODS We calculated the cost per mutation detected and analyzed the cost-effectiveness of performing selected PTEN testing among CS-like patients using a semi-quantitative score (the PTEN Cleveland Clinic [CC] score) compared with existing diagnostic criteria. In our model, first-degree relatives of the patients with detected PTEN mutations are offered PTEN testing. All individuals with detected PTEN mutations are offered cancer surveillance. RESULTS CC score at a threshold of 15 (CC15) costs from $3,720 to $4,573 to detect one PTEN mutation, which is the most inexpensive among the different strategies. At base-case, CC10 is the most cost-effective strategy for female patients who are younger than 40 years, and CC15 is the most cost-effective strategy for female patients who are between 40 and 60 years of age and male patients of all ages. In sensitivity analyses, CC15 is robustly the most cost-effective strategy for probands who are younger than 60 years. CONCLUSION Use of the CC score as a clinical risk calculator is a cost-effective prescreening method to identify CS-like patients for PTEN germline testing.
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Affiliation(s)
- Joanne Ngeow
- Joanne Ngeow, Charis Eng, Cleveland Clinic; Charis Eng, Case Western Reserve University and School of Medicine, Cleveland, Ohio; Joanne Ngeow, National Cancer Centre; Joanne Ngeow, Chang Liu, Ke Zhou, David B. Matchar, Duke-NUS Graduate Medical School, Singapore; and Kevin D. Frick, The Johns Hopkins Carey Business School, Baltimore, MD
| | - Chang Liu
- Joanne Ngeow, Charis Eng, Cleveland Clinic; Charis Eng, Case Western Reserve University and School of Medicine, Cleveland, Ohio; Joanne Ngeow, National Cancer Centre; Joanne Ngeow, Chang Liu, Ke Zhou, David B. Matchar, Duke-NUS Graduate Medical School, Singapore; and Kevin D. Frick, The Johns Hopkins Carey Business School, Baltimore, MD
| | - Ke Zhou
- Joanne Ngeow, Charis Eng, Cleveland Clinic; Charis Eng, Case Western Reserve University and School of Medicine, Cleveland, Ohio; Joanne Ngeow, National Cancer Centre; Joanne Ngeow, Chang Liu, Ke Zhou, David B. Matchar, Duke-NUS Graduate Medical School, Singapore; and Kevin D. Frick, The Johns Hopkins Carey Business School, Baltimore, MD
| | - Kevin D Frick
- Joanne Ngeow, Charis Eng, Cleveland Clinic; Charis Eng, Case Western Reserve University and School of Medicine, Cleveland, Ohio; Joanne Ngeow, National Cancer Centre; Joanne Ngeow, Chang Liu, Ke Zhou, David B. Matchar, Duke-NUS Graduate Medical School, Singapore; and Kevin D. Frick, The Johns Hopkins Carey Business School, Baltimore, MD
| | - David B Matchar
- Joanne Ngeow, Charis Eng, Cleveland Clinic; Charis Eng, Case Western Reserve University and School of Medicine, Cleveland, Ohio; Joanne Ngeow, National Cancer Centre; Joanne Ngeow, Chang Liu, Ke Zhou, David B. Matchar, Duke-NUS Graduate Medical School, Singapore; and Kevin D. Frick, The Johns Hopkins Carey Business School, Baltimore, MD
| | - Charis Eng
- Joanne Ngeow, Charis Eng, Cleveland Clinic; Charis Eng, Case Western Reserve University and School of Medicine, Cleveland, Ohio; Joanne Ngeow, National Cancer Centre; Joanne Ngeow, Chang Liu, Ke Zhou, David B. Matchar, Duke-NUS Graduate Medical School, Singapore; and Kevin D. Frick, The Johns Hopkins Carey Business School, Baltimore, MD
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7
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Ouédraogo S, Dabakuyo-Yonli TS, Roussot A, Dialla PO, Pornet C, Poillot ML, Soler-Michel P, Sarlin N, Lunaud P, Desmidt P, Paré E, Mathis C, Rymzhanova R, Kuntz-Huon J, Exbrayat C, Bataillard A, Régnier V, Kalecinski J, Quantin C, Dumas A, Gentil J, Amiel P, Chauvin F, Dancourt V, Arveux P. [Breast cancer screening in thirteen French departments]. Bull Cancer 2015; 102:126-38. [PMID: 25636359 DOI: 10.1016/j.bulcan.2014.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/04/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND In France, breast cancer screening programme, free of charge for women aged 50-74 years old, coexists with an opportunistic screening and leads to reduction in attendance in the programme. Here, we reported participation in organized and/or opportunistic screening in thirteen French departments. POPULATION AND METHODS We analyzed screening data (organized and/or opportunistic) of 622,382 women aged 51-74 years old invited to perform an organized mammography screening session from 2010 to 2011 in the thirteen French departments. The type of mammography screening performed has been reported according to women age, their health insurance scheme, the rurality and the socioeconomic level of their area or residence. We also represented the tertiles of deprivation and participation in mammography screening for each department. RESULTS A total of 390,831 (62.8%) women performed a mammography screening (organized and/or opportunistic) after the invitation. These women were mainly aged from 55-69 years old, insured by the general insurance scheme and lived in urban, semi-urban or affluent areas. CONCLUSION The participation in mammography screening (organized and opportunistic) in France remains below the target rate of 70% expected by health authorities to reduce breast cancer mortality through screening.
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Affiliation(s)
- Samiratou Ouédraogo
- Centre régional de lutte contre le cancer Georges-François Leclerc, registre des cancers du sein et autres cancers gynécologiques de Côte-d'Or, 1, rue Professeur-Marion, 21000 Dijon, France; Université de Bourgogne, faculté de médecine et de pharmacie de Dijon, EA 4184, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
| | - Tienhan Sandrine Dabakuyo-Yonli
- Université de Bourgogne, faculté de médecine et de pharmacie de Dijon, EA 4184, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France; Centre régional de lutte contre le cancer Georges-François-Leclerc, unité de biostatistiques et de qualité de vie, 1, rue Professeur-Marion, 21000 Dijon, France
| | - Adrien Roussot
- Centre hospitalier universitaire, service de biostatistiques et d'informatique médicale, BP 77908, 21000 Dijon, France
| | - Pegdwendé Olivia Dialla
- Centre régional de lutte contre le cancer Georges-François Leclerc, registre des cancers du sein et autres cancers gynécologiques de Côte-d'Or, 1, rue Professeur-Marion, 21000 Dijon, France; Université de Bourgogne, faculté de médecine et de pharmacie de Dijon, EA 4184, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Carole Pornet
- CHU de Caen, département de recherche épidémiologique et évaluation, 14000 Caen, France; Université de Caen, faculté de médecine, EA3936, 14000 Basse-Normandie, Caen, France; Université de Caen Basse-Normandie, faculté de médecine, U1086 Inserm, cancers et prévention, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Marie-Laure Poillot
- Centre régional de lutte contre le cancer Georges-François Leclerc, registre des cancers du sein et autres cancers gynécologiques de Côte-d'Or, 1, rue Professeur-Marion, 21000 Dijon, France; Université de Bourgogne, faculté de médecine et de pharmacie de Dijon, EA 4184, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Patricia Soler-Michel
- Association pour le dépistage organisé des cancers dans le Rhône (Adémas-69), 5 bis, rue Cléberg, 69322 Lyon cedex 05, France
| | - Nathalie Sarlin
- Caisse primaire d'Assurance maladie de la Côte-d'Or, 8, rue du Dr-Maret, 21000 Dijon, France
| | - Philippe Lunaud
- Régime social des indépendants de Bourgogne, 41, rue de Mulhouse, 21000 Dijon, France
| | - Pascal Desmidt
- Mutualité sociale agricole de Bourgogne, 14, rue Félix-Trutat, 21000 Dijon, France
| | - Etienne Paré
- Drôme Ardèche prévention cancer (DAPC), 9, rue Georges-Méliès, 26000 Valence, France
| | - Corinne Mathis
- Réseau pour le dépistage des cancers en Haute-Savoie (RDC 74), 12, avenue de Chevenne, BP 50126, 74003 Annecy cedex, France
| | - Rachouan Rymzhanova
- Association pour le dépistage des cancers en Franche-Comté (ADECA-FC), 3, rue Paul-Bert, 25000 Besançon, France
| | - Janine Kuntz-Huon
- VIVRE 42 !, 58, rue Robespierre, BP 20279, 42014 Saint-Étienne cedex 2, France
| | - Catherine Exbrayat
- Office de lutte contre le cancer en Isère (ODLC Isère), 19, chemin de la Dhuy, Maupertuis, BP 139, 38244 Meylan, France
| | - Anne Bataillard
- Office de lutte contre le cancer dans l'Ain (ODLC Ain), 12, rue de la Grenouillère, 01000 Bour-en-Bresse, France
| | - Véronique Régnier
- Institut de cancérologie Lucien-Neuwirth, CIC-EC 3 Inserm, IFR 143, 42000 Saint-Étienne, France
| | - Julie Kalecinski
- Institut de cancérologie Lucien-Neuwirth, CIC-EC 3 Inserm, IFR 143, 42000 Saint-Étienne, France
| | - Catherine Quantin
- Centre hospitalier universitaire, service de biostatistiques et d'informatique médicale, BP 77908, 21000 Dijon, France; Université de Bourgogne, Inserm U866, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Agnès Dumas
- Institut de cancérologie Gustave-Roussy, 94805 Villejuif cedex, France
| | - Julie Gentil
- Centre régional de lutte contre le cancer Georges-François Leclerc, registre des cancers du sein et autres cancers gynécologiques de Côte-d'Or, 1, rue Professeur-Marion, 21000 Dijon, France; Université de Bourgogne, faculté de médecine et de pharmacie de Dijon, EA 4184, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Philippe Amiel
- Institut de cancérologie Gustave-Roussy, 94805 Villejuif cedex, France
| | - Franck Chauvin
- Institut de cancérologie Lucien-Neuwirth, CIC-EC 3 Inserm, IFR 143, 42000 Saint-Étienne, France; Université Lyon 1, hospices civils de Lyon, CNRS UMR 5558, 69002 Lyon, France
| | - Vincent Dancourt
- Université de Bourgogne, Inserm U866, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France; Association pour le dépistage des cancers en Côte-d'Or et dans la Nièvre (ADECA 21-58), 16-18, rue Nodot, 21000 Dijon, France
| | - Patrick Arveux
- Centre régional de lutte contre le cancer Georges-François Leclerc, registre des cancers du sein et autres cancers gynécologiques de Côte-d'Or, 1, rue Professeur-Marion, 21000 Dijon, France; Université de Bourgogne, faculté de médecine et de pharmacie de Dijon, EA 4184, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
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Kalecinski J, Régnier-Denois V, Ouédraogo S, Dabakuyo-Yonli TS, Dumas A, Arveux P, Chauvin F. Dépistage organisé ou individuel du cancer du sein ? Attitudes et représentations des femmes. SANTE PUBLIQUE 2015. [DOI: 10.3917/spub.152.0213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cost-effectiveness of population-based mammography screening strategies by age range and frequency. J Cancer Policy 2014. [DOI: 10.1016/j.jcpo.2014.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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10
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European transnational ecological deprivation index and participation in population-based breast cancer screening programmes in France. Prev Med 2014; 63:103-8. [PMID: 24345603 DOI: 10.1016/j.ypmed.2013.12.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 12/05/2013] [Accepted: 12/07/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND We investigated factors explaining low breast cancer screening programme (BCSP) attendance taking into account a European transnational ecological Deprivation Index. PATIENTS AND METHODS Data of 13,565 women aged 51-74years old invited to attend an organised mammography screening session between 2010 and 2011 in thirteen French departments were randomly selected. Information on the women's participation in BCSP, their individual characteristics and the characteristics of their area of residence were recorded and analysed in a multilevel model. RESULTS Between 2010 and 2012, 7121 (52.5%) women of the studied population had their mammography examination after they received the invitation. Women living in the most deprived neighbourhood were less likely than those living in the most affluent neighbourhood to participate in BCSP (OR 95%CI=0.84[0.78-0.92]) as were those living in rural areas compared with those living in urban areas (OR 95%CI=0.87[0.80-0.95]). Being self-employed (p<0.0001) or living more than 15min away from an accredited screening centre (p=0.02) was also a barrier to participation in BCSP. CONCLUSION Despite the classless delivery of BCSP, inequalities in uptake remain. To take advantage of prevention and to avoid exacerbating disparities in cancer mortality, BCSP should be adapted to women's personal and contextual characteristics.
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Duport N. Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey. Rev Epidemiol Sante Publique 2012; 60:421-30. [DOI: 10.1016/j.respe.2012.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/23/2012] [Accepted: 05/07/2012] [Indexed: 11/28/2022] Open
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Schousboe JT, Kerlikowske K, Loh A, Cummings SR. Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Ann Intern Med 2011; 155:10-20. [PMID: 21727289 PMCID: PMC3759993 DOI: 10.7326/0003-4819-155-1-201107050-00003] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current guidelines recommend mammography every 1 or 2 years starting at age 40 or 50 years, regardless of individual risk for breast cancer. OBJECTIVE To estimate the cost-effectiveness of mammography by age, breast density, history of breast biopsy, family history of breast cancer, and screening interval. DESIGN Markov microsimulation model. DATA SOURCES Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and the medical literature. TARGET POPULATION U.S. women aged 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years with initial mammography at age 40 years and breast density of Breast Imaging Reporting and Data System (BI-RADS) categories 1 to 4. TIME HORIZON Lifetime. PERSPECTIVE National health payer. INTERVENTION Mammography annually, biennially, or every 3 to 4 years or no mammography. OUTCOME MEASURES Costs per quality-adjusted life-year (QALY) gained and number of women screened over 10 years to prevent 1 death from breast cancer. RESULTS OF BASE-CASE ANALYSIS Biennial mammography cost less than $100,000 per QALY gained for women aged 40 to 79 years with BI-RADS category 3 or 4 breast density or aged 50 to 69 years with category 2 density; women aged 60 to 79 years with category 1 density and either a family history of breast cancer or a previous breast biopsy; and all women aged 40 to 79 years with both a family history of breast cancer and a previous breast biopsy, regardless of breast density. Biennial mammography cost less than $50,000 per QALY gained for women aged 40 to 49 years with category 3 or 4 breast density and either a previous breast biopsy or a family history of breast cancer. Annual mammography was not cost-effective for any group, regardless of age or breast density. RESULTS OF SENSITIVITY ANALYSIS Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered. LIMITATION Results are not applicable to carriers of BRCA1 or BRCA2 mutations. CONCLUSION Mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of breast cancer, and beliefs about the potential benefit and harms of screening. PRIMARY FUNDING SOURCE Eli Lilly, Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and Breast Cancer Surveillance Consortium.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Health Services, Minneapolis, Minnesota 55416, USA.
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13
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Uhry Z, Hédelin G, Colonna M, Asselain B, Arveux P, Exbrayat C, Guldenfelds C, Soler-Michel P, Molinié F, Trétarre B, Rogel A, Courtial I, Danzon A, Guizard A, Ancelle-Park R, Eilstein D, Duffy S. Modelling the effect of breast cancer screening on related mortality using French data. Cancer Epidemiol 2011; 35:235-42. [DOI: 10.1016/j.canep.2010.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/22/2010] [Accepted: 10/31/2010] [Indexed: 11/29/2022]
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Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, Pillonel J, Poullié AI, Scemama O, Deuffic-Burban S, Losina E, Walensky RP, Freedberg KA, Paltiel AD. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One 2010; 5:e13132. [PMID: 20976112 PMCID: PMC2956760 DOI: 10.1371/journal.pone.0013132] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/05/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. METHODS/PRINCIPAL FINDINGS We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing ("current practice") to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. "Current practice" produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. CONCLUSIONS/SIGNIFICANCE One-time routine HIV screening in France improves survival compared to "current practice" and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.
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Affiliation(s)
- Yazdan Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France.
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Goldhaber-Fiebert JD, Stout NK, Goldie SJ. Empirically evaluating decision-analytic models. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:667-674. [PMID: 20230547 DOI: 10.1111/j.1524-4733.2010.00698.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Model-based cost-effectiveness analyses support decision-making. To augment model credibility, evaluation via comparison to independent, empirical studies is recommended. METHODS We developed a structured reporting format for model evaluation and conducted a structured literature review to characterize current model evaluation recommendations and practices. As an illustration, we applied the reporting format to evaluate a microsimulation of human papillomavirus and cervical cancer. The model's outputs and uncertainty ranges were compared with multiple outcomes from a study of long-term progression from high-grade precancer (cervical intraepithelial neoplasia [CIN]) to cancer. Outcomes included 5 to 30-year cumulative cancer risk among women with and without appropriate CIN treatment. Consistency was measured by model ranges overlapping study confidence intervals. RESULTS The structured reporting format included: matching baseline characteristics and follow-up, reporting model and study uncertainty, and stating metrics of consistency for model and study results. Structured searches yielded 2963 articles with 67 meeting inclusion criteria and found variation in how current model evaluations are reported. Evaluation of the cervical cancer microsimulation, reported using the proposed format, showed a modeled cumulative risk of invasive cancer for inadequately treated women of 39.6% (30.9-49.7) at 30 years, compared with the study: 37.5% (28.4-48.3). For appropriately treated women, modeled risks were 1.0% (0.7-1.3) at 30 years, study: 1.5% (0.4-3.3). CONCLUSIONS To support external and projective validity, cost-effectiveness models should be iteratively evaluated as new studies become available, with reporting standardized to facilitate assessment. Such evaluations are particularly relevant for models used to conduct comparative effectiveness analyses.
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Affiliation(s)
- Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Uhry Z, Hédelin G, Colonna M, Asselain B, Arveux P, Rogel A, Exbrayat C, Guldenfels C, Courtial I, Soler-Michel P, Molinié F, Eilstein D, Duffy SW. Multi-state Markov models in cancer screening evaluation: a brief review and case study. Stat Methods Med Res 2010; 19:463-86. [PMID: 20231370 DOI: 10.1177/0962280209359848] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This work presents a brief overview of Markov models in cancer screening evaluation and focuses on two specific models. A three-state model was first proposed to estimate jointly the sensitivity of the screening procedure and the average duration in the preclinical phase, i.e. the period when the cancer is asymptomatic but detectable by screening. A five-state model, incorporating lymph node involvement as a prognostic factor, was later proposed combined with a survival analysis to predict the mortality reduction associated with screening. The strengths and limitations of these two models are illustrated using data from French breast cancer service screening programmes. The three-state model is a useful frame but parameter estimates should be interpreted with caution. They are highly correlated and depend heavily on the parametric assumptions of the model. Our results pointed out a serious limitation to the five-state model, due to implicit assumptions which are not always verified. Although it may still be useful, there is a need for more flexible models. Over-diagnosis is an important issue for both models and induces bias in parameter estimates. It can be addressed by adding a non-progressive state, but this may provide an uncertain estimation of over-diagnosis. When the primary goal is to avoid bias, rather than to estimate over-diagnosis, it may be more appropriate to correct for over-diagnosis assuming different levels in a sensitivity analysis. This would be particularly relevant in a perspective of mortality reduction estimation.
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Affiliation(s)
- Z Uhry
- Département des Maladies Chroniques et des Traumatismes, Institut de veille sanitaire, St-Maurice, France.
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Are breast cancer screening practices associated with sociodemographic status and healthcare access? Analysis of a French cross-sectional study. Eur J Cancer Prev 2008; 17:218-24. [PMID: 18414192 DOI: 10.1097/cej.0b013e3282b6fde5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to analyse the role of women's sociodemographic and healthcare access characteristics according to breast cancer screening practices (organized, individual or no screening). A cross-sectional study was set up in seven French districts using a self-administered postal questionnaire. Randomization was stratified proportionally on age and urban/rural status in each district separately among attendees and nonattendees to the organized breast cancer screening programme (OS). A total of 5638 women aged 50-74 years returned their questionnaires: 1480 in the attendee OS group and 4158 in the nonattendee group. Among them, 3537 declared having undergone a recent mammography outside the organized programme (individual, IS group) and 621 declared never having undergone a mammography or having done so more than 2 years ago (NS group). Analyses showed a gradient between the three groups (IS, OS and NS, respectively) in their association with breast cancer screening practices considering three factors: an increasing gradient was observed for renunciation of basic healthcare for financial reasons, a decreasing gradient in the regular visit to a medical gynaecologist and having had a Pap smear in the last 3 years. Three other variables that showed a decreasing gradient are: living with a partner, current use of hormone replacement therapy and having had a check-up in the last 5 years. In conclusion, the main differences between breast cancer screening practices were largely associated with difficulties in healthcare access, considering regular gynaecological visits in particular.
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Rojnik K, Naversnik K, Mateović-Rojnik T, Primiczakelj M. Probabilistic cost-effectiveness modeling of different breast cancer screening policies in Slovenia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:139-148. [PMID: 18380626 DOI: 10.1111/j.1524-4733.2007.00223.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To determine the most cost-effective screening policy for population-based mammography breast cancer screening in Slovenia using probabilistic sensitivity analysis. METHODS A time-dependent Markov model for breast cancer was constructed. General principles of cost-effectiveness analysis with multiple strategies were used to compare the costs and effects of 36 different screening policies. Using probability distributions for model parameters, the true effect of uncertainty across model input parameters on expected costs and effects was explored. The results from probabilistic simulation analysis are presented in a form of cost-effectiveness acceptability curves with cost-effectiveness acceptability frontier. RESULTS With the presented analysis, it was shown that a 1-year screening interval in population breast cancer screening would produce less benefits at higher costs than less intensive screening and that a 2-year interval would be cost-effective only at high values of society's willingness to pay per quality-adjusted life-year (QALY). Therefore, the optimal screening policy should be chosen among 3-year-interval policies. CONCLUSIONS Based on commonly quoted thresholds of society's willingness to pay per QALY of $50,000, the optimal approach in the Slovenian population would be screening women aged from 40 to 80 years every 3 years.
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Affiliation(s)
- Klemen Rojnik
- Roche d.o.o. farmacevtska druZba, Vodovodna, Ljubljana, Slovenia.
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Duport N, Ancelle-Park R. Do socio-demographic factors influence mammography use of French women? Analysis of a French cross-sectional survey. Eur J Cancer Prev 2006; 15:219-24. [PMID: 16679864 DOI: 10.1097/01.cej.0000198902.78420.de] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to analyse the independent role of socio-demographic factors on the use of mammography according to whether or not an organized breast cancer screening programme exists. The study sample of 2825 women aged 40-74 years was drawn from a cross-sectional population-based survey of French households. Among these women 46% lived in districts that offered a screening programme and 63% reported undergoing mammography in the previous 2 years. Living in a district that offered a screening programme was associated with increased use of mammography. According to both univariate and multivariate analysis, several socio-demographic characteristics, such as high monthly household income or high education level, increased the probability of using mammography. However, three factors had a major positive impact on its use: (1) having had a gynaecological examination in the previous 2 years, (2) living in a district where a screening programme was available, and (3) age. There was a significant interaction between the factors 2 and 3. Between 40 and 60 years, age had the same impact on the use of mammography whether or not women lived in a district with a screening programme. After the age of 60 years, the use of mammography collapsed among women living in a district without a screening programme and remained frequent among women living in the district that offered such a programme. Even if the overall level of mammography screening was high and the existence of a screening programme maintained a high level of mammography use among older women, the programme should target better the women of underprivileged spheres and reinforce the role of the general practitioner; in particular for women not followed by a gynaecologist.
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Affiliation(s)
- Nicolas Duport
- Institut de Veille Sanitaire, Département des Maladies Chroniques et des Traumatismes, Saint-Maurice, France.
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Herida M, Larsen C, Lot F, Laporte A, Desenclos JC, Hamers FF. Cost-effectiveness of HIV post-exposure prophylaxis in France. AIDS 2006; 20:1753-61. [PMID: 16931940 DOI: 10.1097/01.aids.0000242822.74624.5f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of HIV post-exposure prophylaxis (PEP) in France. METHODS We used a decision tree to evaluate, from a society's perspective, the cost of PEP per quality-adjusted life-year (QALY) saved. We used 1999-2003 PEP surveillance data and literature-derived data on per event transmission probabilities, PEP efficacy and quality of life with HIV. HIV prevalence and lifetime cost of HIV/AIDS management in the HAART era were derived from French studies. We assumed that mean life expectancy in full health was 65 years among uninfected individuals and that the mean survival time after HIV infection was 22.5 years. The costs of PEP drugs and follow-up were derived from the French public sector. A 3% annual rate was used to discount future costs and effects. RESULTS During 1999-2003, PEP was prescribed to 8958 individuals (heterosexual sex: 47.6%; homosexual sex: 28.4%; occupational exposure: 23.4%; drug injection: 0.6%); of those, 2143 were exposed to a known HIV-infected source. PEP was estimated to prevent 7.7 infections and saved 64.5 QALY at a net cost of euro 5.7 million, resulting in an overall cost-effectiveness ratio of euro 88,692 per QALY saved. PEP was cost saving for 4.4% of cases and cost effective (< euro 50,000 per QALY) in a further 11.3% of cases. In contrast, 72 and 52% of prescriptions had a cost-effectiveness ratio exceeding euro 200,000 and euro 2 millions, respectively, per QALY saved. CONCLUSION Overall, the French PEP programme is only moderately cost effective. PEP guidelines should be revised to target high-risk exposures better.
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Affiliation(s)
- Magid Herida
- Department of Infectious Diseases, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice cedex, France.
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Lejeune C, Arveux P, Dancourt V, Béjean S, Bonithon-Kopp C, Faivre J. Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer. Int J Technol Assess Health Care 2005; 20:434-9. [PMID: 15609792 DOI: 10.1017/s0266462304001321] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50-74 years of age. METHODS A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data. RESULTS Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3357 Euro per life-year gained among individuals 50-74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test. CONCLUSIONS Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.
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