de Gelder Rianne, Bulliard Jean-Luc, de Wolf Chris, Fracheboud Jacques, Draisma Gerrit, Schopper Doris, de Koning Harry J
Erasmus MC, Department of Public Health, Rotterdam, The Netherlands.
Eur J Cancer. 2009 Jan;45(1):127-38. doi: 10.1016/j.ejca.2008.09.015. Epub 2008 Nov 27.
Various centralised mammography screening programmes have shown to reduce breast cancer mortality at reasonable costs. However, mammography screening is not necessarily cost-effective in every situation. Opportunistic screening, the predominant screening modality in several European countries, may under certain circumstances be a cost-effective alternative. In this study, we compared the cost-effectiveness of both screening modalities in Switzerland.
Using micro-simulation modelling, we predicted the effects and costs of biennial mammography screening for 50-69 years old women between 1999 and 2020, in the Swiss female population aged 30-70 in 1999. A sensitivity analysis on the test sensitivity of opportunistic screening was performed.
Organised mammography screening with an 80% participation rate yielded a breast cancer mortality reduction of 13%. Twenty years after the start of screening, the predicted annual breast cancer mortality was 25% lower than in a situation without screening. The 3% discounted cost-effectiveness ratio of organised mammography screening was euro11,512 per life year gained. Opportunistic screening with a similar participation rate was comparably effective, but at twice the costs: euro22,671-24,707 per life year gained. This was mainly related to the high costs of opportunistic mammography and frequent use of imaging diagnostics in combination with an opportunistic mammogram.
Although data on the performance of opportunistic screening are limited, both opportunistic and organised mammography screening seem effective in reducing breast cancer mortality in Switzerland. However, for opportunistic screening to become equally cost-effective as organised screening, costs and use of additional diagnostics should be reduced.
各种集中式乳腺钼靶筛查项目已证明能以合理成本降低乳腺癌死亡率。然而，乳腺钼靶筛查并非在每种情况下都具有成本效益。机会性筛查是几个欧洲国家的主要筛查方式，在某些情况下可能是一种具有成本效益的替代方法。在本研究中，我们比较了这两种筛查方式在瑞士的成本效益。
我们使用微观模拟模型，预测了1999年至2020年期间对1999年年龄在30 - 70岁的瑞士女性人群中50 - 69岁女性进行两年一次乳腺钼靶筛查的效果和成本。对机会性筛查的检测敏感性进行了敏感性分析。
参与率为80%的有组织乳腺钼靶筛查使乳腺癌死亡率降低了13%。筛查开始20年后，预测的年度乳腺癌死亡率比未进行筛查的情况低25%。有组织乳腺钼靶筛查的3%贴现成本效益比为每获得一个生命年11,512欧元。参与率相似的机会性筛查效果相当，但成本是其两倍：每获得一个生命年22,671 - 24,707欧元。这主要与机会性乳腺钼靶检查的高成本以及与机会性乳腺钼靶检查结合频繁使用影像诊断有关。
尽管关于机会性筛查效果的数据有限，但机会性和有组织的乳腺钼靶筛查在瑞士似乎都能有效降低乳腺癌死亡率。然而，要使机会性筛查与有组织筛查具有同等成本效益，应降低成本和额外诊断的使用。
