OBJECTIVES: In England, the National Health Service Breast Screening Programme (NHSBSP) invites women aged 50–70 years to attend for 3-yearly mammograms. There has been growing interest in the use of personalised screening programmes to improve the benefits of breast cancer screening. This study aimed to evaluate the cost-effectiveness of the NHSBSP and personalised screening programmes.

METHODS: A patient-level discrete-event simulation was developed to simulate population screening in cohort of woman, with lifetime outcomes. Health related quality of life, cancer survival and treatment costs are estimated in the model and depend on cancer stage (non-invasive cancer and four invasive cancer stages), age at cancer detection and duration of time since the cancer was detected. Tumour detection at screening was modelled to be dependent on breast density, tumour size and screening instrument. The modelled benefit of screening is that it can lead to earlier detection. Harms of screening were overdiagnosis, pain incurred during mammography screening and the distress caused by false positive results.

Personalised screening programmes varied with respect to the screening instruments used, frequency of screening, and identification and categorisation of risk. Model outcomes were validated against audit data from the national screening programme.

RESULTS: Compared with no screening, all of the screening programmes generated additional costs and additional QALYs. All of the personalised screening programmes also generate more costs and QALYs than current screening. No screening amongst the lowest risk group and annual screening amongst the highest risk groups generally provided more favourable health economic outcomes than other screening strategies.

CONCLUSIONS: Risk stratified breast cancer screening has the potential to be beneficial for women, but cost-effectiveness will depend on the particular risk-based strategy. Not offering breast cancer screening to women at the lowest risk of breast cancer improves the cost-effectiveness of population-level screening by reducing its harms.