Risk stratification in breast cancer screening: Cost-effectiveness and harm-benefit ratios for low-risk and high-risk women
Risk stratification in breast cancer screening: Cost-effectiveness and harm-benefit ratios for low-risk and high-risk women
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DOI：
10.1002/ijc.33126
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发表时间：
2020-06-30
影响因子：
6.4
通讯作者：
de Koning, Harry J.
中科院分区：
文献类型：
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作者：
Sankatsing, Valerie D. V.;van Ravesteyn, Nicolien T.;de Koning, Harry J.
在乳房X光检查方案中，妇女是按照“一刀切”的原则接受检查的。根据风险水平进行量身定制的筛查可能会更好地平衡获益和危害。通过微观模拟建模，我们确定了最佳的乳腺X线摄影筛查策略，用于低于（相对风险[RR] 0.75）和高于（RR 1.8）乳腺癌平均风险的女性，符合筛查条件，使用荷兰目前统一筛查（两年一次[B] 50-74）的增量成本效益比（ICER）作为阈值ICER。策略因时间间隔（一年一次[A]、两年一次、三年一次[T]）和年龄范围而异。计算获得的生命年数（LYG）、避免的乳腺癌死亡数、过度诊断病例数、假阳性乳腺X线照片、ICER和损害-受益比。最佳的基于风险的筛查方案，低于8883欧元/LYG的阈值ICER，低风险妇女为T50-71（7840欧元/LYG），高风险妇女为B40-74（6062欧元/LYG）。在低风险妇女中进行T50-71筛查，与目前的筛查计划相比，假阳性结果减少了33%，成本降低了类似的降低，并改善了危害-效益比。与目前的B50-74筛查相比，B40 - 74在高危妇女中的筛查益处增加，但假阳性结果增加相对较高。总之，最佳筛查包括较长的间隔和较低的停止年龄比目前的统一筛选低风险的妇女，和一个较低的开始年龄为高风险的妇女。将风险较低的女性的筛查间隔从两年一次延长到三年一次，在保持大部分筛查益处的同时，降低了危害和成本。
In mammography screening programmes, women are screened according to a one-size-fits-all principle. Tailored screening, based on risk levels, may lead to a better balance of benefits and harms. With microsimulation modelling, we determined optimal mammography screening strategies for women at lower (relative risk [RR] 0.75) and higher (RR 1.8) than average risk of breast cancer, eligible for screening, using the incremental cost-effectiveness ratio (ICER) of current uniform screening in the Netherlands (biennial [B] 50-74) as a threshold ICER. Strategies varied by interval (annual [A], biennial, triennial [T]) and age range. The number of life-years gained (LYG), breast cancer deaths averted, overdiagnosed cases, false-positive mammograms, ICERs and harm-benefit ratios were calculated. Optimal risk-based screening scenarios, below the threshold ICER of euro8883/LYG, were T50-71 (euro7840/LYG) for low-risk and B40-74 (euro6062/LYG) for high-risk women. T50-71 screening in low-risk women resulted in a 33% reduction in false-positive findings, a similar reduction in costs and improved harm-benefit ratios compared to the current screening schedule. B40-74 in high-risk women led to an increase in screening benefit, compared to current B50-74 screening, but a relatively higher increase in false-positive findings. In conclusion, optimal screening consisted of a longer interval and lower stopping age than current uniform screening for low-risk women, and a lower starting age for high-risk women. Extending the interval for women at lower risk from biennial to triennial screening reduced harms and costs while maintaining most of the screening benefit.