Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer

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• dc.contributor.author Vilaprinyó, Ester
• dc.contributor.author Forné, Carles
• dc.contributor.author Carles, Misericòrdia
• dc.contributor.author Sala, Maria
• dc.contributor.author Pla, Roger
• dc.contributor.author Castells, Xavier
• dc.contributor.author Domingo, Laia
• dc.contributor.author Rué, Montserrat
• dc.contributor.author Interval Cancer (INCA) Study Group
• dc.date.accessioned 2025-01-10T07:19:13Z
• dc.date.available 2025-01-10T07:19:13Z
• dc.date.issued 2014
• dc.description.abstract The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.
• dc.format.mimetype application/pdf
• dc.identifier.citation Vilaprinyo E, Forné C, Carles M, Sala M, Pla R, Castells X, et al. Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer. PLoS One. 2014 Feb 3;9(2):e86858. DOI: 10.1371/journal.pone.0086858
• dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0086858
• dc.identifier.issn 1932-6203
• dc.identifier.uri http://hdl.handle.net/10230/69041
• dc.language.iso eng
• dc.publisher Public Library of Science (PLoS)
• dc.relation.ispartof PLoS One. 2014 Feb 3;9(2):e86858
• dc.rights © 2014 Vilaprinyo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Cancer risk factors
• dc.subject.keyword Breast cancer
• dc.subject.keyword Mammography
• dc.subject.keyword Cancer screening
• dc.subject.keyword Cost-effectiveness analysis
• dc.subject.keyword Cancer detection and diagnosis
• dc.subject.keyword Invasive tumors
• dc.subject.keyword Screening guidelines
• dc.title Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion