The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria

Sep 1, 2017, 00:00
10.1016/j.jval.2017.04.009
https://www.valueinhealthjournal.com/article/S1098-3015(17)30209-7/fulltext
Title : The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(17)30209-7&doi=10.1016/j.jval.2017.04.009
First page : 1048
Section Title : ECONOMIC EVALUATION
Open access? : No
Section Order : 7

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.

Categories :
Tags :
  • breast cancer
  • cost-effectiveness analysis
  • mass screening
  • microsimulation
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