Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women
Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women
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DOI：
10.1016/j.jval.2018.07.880
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发表时间：
2019-02-01
期刊：
影响因子：
4.5
通讯作者：
Shen, Yu
中科院分区：
文献类型：
--
作者：
Shih, Ya-Chen Tina;Dong, Wenli;Shen, Yu
背景：几个专业协会最近于 2015 年底/2016 年初更新了其乳腺癌筛查指南。 目标：评估美国乳房 X 线摄影筛查指南的成本效益。方法：我们开发了一个微观模拟模型来生成浸润性乳腺癌的自然史，并捕捉筛查和治疗如何改变疾病的自然病程。我们使用该模型评估了筛查策略的成本效益，包括从 40 岁开始每年筛查、从 50 岁开始每两年筛查一次，以及从 45 岁开始筛查并在 55 岁过渡到每两年筛查一次的混合策略，并结合三个停止年龄：75 岁、80 岁和无年龄上限。研究结果被总结为增量成本效益比（每质量调整生命年的成本[QALY]）和成本效益可接受边界。结果：从 45 岁开始每年进行一次乳房 X 光检查并在 55 岁至 75 岁之间改为每两年一次筛查的筛查策略最具成本效益，增量成本效益比为 40,135 美元/QALY。概率分析表明，当社会支付意愿在 44,000 美元/QALY 至 103,500 美元/QALY 之间时，混合策略达到最优的概率最高。在普遍接受的社会支付意愿范围内，没有最佳策略涉及80岁或以上的戒烟年龄。结论：基于混合设计的筛查策略对于普通风险女性来说是最具成本效益的。通过在形成建议时考虑利弊之间的平衡，这种混合筛查策略有可能优化医疗保健系统在乳腺癌早期检测和治疗方面的投资。
Background: Several specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016. Objectives: To evaluate the cost-effectiveness of US-based mammography screening guidelines. Methods: We developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier. Results: The screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older. Conclusions: The screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system's investment in the early detection and treatment of breast cancer.