Cost-effectiveness of Digital Breast Tomosynthesis in Population-based Breast Cancer Screening: A Probabilistic Sensitivity Analysis
Cost-effectiveness of Digital Breast Tomosynthesis in Population-based Breast Cancer Screening: A Probabilistic Sensitivity Analysis
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DOI：
10.1148/radiol.2020192505
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发表时间：
2020-10-01
期刊：
影响因子：
19.7
通讯作者：
van Ravesteyn, Nicolien T.
中科院分区：
文献类型：
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作者：
Sankatsing, Valerie D. V.;Juraniec, Karolina;van Ravesteyn, Nicolien T.
背景资料：数字乳腺断层合成摄影（DBT）是一种很有前途的筛查测试，但其结果和成本效益仍不确定。目的：确定与荷兰的数字乳腺X射线摄影（DM）相比，两年一次的DBT在筛查环境中是否具有成本效益，并量化不确定性。材料和方法：在本研究中，从2018年3月至2019年2月进行，使用微模拟SCreening分析模型进行概率敏感性分析（PSA），包括10 000次模型运行，每次运行模拟1 000 000名妇女。使用贝叶斯成本效益分析包和谢菲尔德加速信息价值工具处理PSA结局。1970年出生的两个模拟队列被邀请在50至74岁之间进行两年一次的筛查-一个队列被分配到DM筛查，一个被分配到DBT筛查。DM输入参数基于荷兰乳腺癌筛查项目的数据。DBT参数基于文献和专家意见。支付意愿阈值为20000（22000美元）和C35000（38500美元）每生命年（LYG）。效果和成本被折扣为3.5%per year.Results：DBT导致增益13额外的生命年每1000名妇女邀请到筛选（7%的增长，13 193），其次是终身，与DM相比，导致2%（4 159）假阳性结果减少。DBT筛查导致5.09 LYG的增量贴现寿命效应（95%置信区间：-0.80，9.70），寿命期成本增加137，555美元（原文如此）（151 311美元）（95%置信区间：（原文如此）31 093 [34 202美元]，（原文如此）263 537 [289 891美元]）与马克相比，平均增量成本效益比为27 023（29 725美元）/LYG。DBT成本效益更高的概率在（原文如此）20 000和（原文如此）35 000/LYG时分别为0.36和0.66。从数字乳腺X射线摄影转换为两年一次的数字乳腺断层合成摄影在每生命年增加20 000美元的支付意愿阈值下不具有成本效益，但是数字乳腺断层合成比数字乳腺X射线摄影具有更高的成本效益概率，阈值为（原文如此）每生命年增加35000。(C)RSNA，2020年
Background: Digital breast tomosynthesis (DBT) is a promising screening test, but its outcomes and cost-effectiveness remain uncertain.Purpose: To determine if biennial DBT is cost-effective in a screening setting, when compared with digital mammography (DM) in the Netherlands, and to quantify the uncertainty.Materials and Methods: In this study, performed from March 2018 to February 2019, the MIcrosimulation SCreening ANalysis model was used to conduct a probabilistic sensitivity analysis (PSA), consisting of 10 000 model runs with 1 000 000 women simulated per run. The Bayesian Cost-Effectiveness Analysis package and the Sheffield Accelerated Value of Information tool were used to process PSA outcomes. Two simulated cohorts born in 1970 were invited to undergo biennial screening between ages 50 and 74 years-one cohort was assigned to DM screening, and one was assigned to DBT screening. DM input parameters were based on data from the Dutch breast cancer screening program. DBT parameters were based on literature and expert opinion. Willingness-to-pay thresholds of 20000 ($22 000) and C35000 ($38500) per life-year gained (LYG) were considered. Effects and costs were discounted at 3.5% per year.Results: DBT resulted in a gain of 13 additional life-years per 1000 women invited to screening (7% increase, 13 of 193), followed over lifetime, compared with DM and led to 2% (four of 159) fewer false-positive results. DBT screening led to incremental discounted lifetime effects of 5.09 LYGs (95% confidence interval: -0.80, 9.70) and an increase in lifetime costs of (sic)137 555 ($151 311) per 1000 women (95% confidence interval: (sic)31 093 [$34 202], (sic)263 537 [$289 891]) compared with DM, resulting in a mean incremental cost-effectiveness ratio of (sic)27 023 ($29 725) per LYG. The probability of DBT being more cost-effective was 0.36 at (sic)20 000 and 0.66 at (sic)35 000 per LYG.Conclusion: Switching from digital mammography to biennial digital breast tomosynthesis is not cost-effective at a willingness-to-pay threshold of (sic)20 000 per life-year gained, but digital breast tomosynthesis has a higher probability of being more cost-effective than digital mammography at a threshold of (sic)35 000 per life-year gained. (C) RSNA, 2020