Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies.
Breast cancer prevention
Breast cancer screening
Cost effectiveness
Decision analysis
Overdiagnosis
Risk stratification
Journal
The European journal of health economics : HEPAC : health economics in prevention and care
ISSN: 1618-7601
Titre abrégé: Eur J Health Econ
Pays: Germany
ID NLM: 101134867
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
02
06
2020
accepted:
10
06
2021
pubmed:
4
8
2021
medline:
25
2
2023
entrez:
3
8
2021
Statut:
ppublish
Résumé
Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.
Identifiants
pubmed: 34342797
doi: 10.1007/s10198-021-01338-5
pii: 10.1007/s10198-021-01338-5
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1311-1344Subventions
Organisme : Horizon 2020 Research and Innovation Programme
ID : 634570
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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