Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Germany; Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Department of Gynecology and Obstetrics, University Hospital rechts der Isar, Technical University Munich, Munich, Germany.
Value Health. 2018 Jul;21(7):799-808. doi: 10.1016/j.jval.2017.12.022. Epub 2018 Feb 21.
Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies.
Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies.
First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000.
Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.
个性化乳腺癌筛查迄今为止一直是基于完全筛查依从性的经济评估。这是第一项评估不依从对个性化筛查策略评估和选择影响的研究。
基于文献研究结果建立了不同的依从性情景。适应了Markov 微模拟模型，以评估这些依从性情景对三种不同的个性化策略的影响。
首先，确定了三种描述风险与依从性之间关系的依从性情景：1）风险与筛查依从性之间存在正相关关系，2）存在负相关关系，或 3）存在曲线关系。其次，在三种个性化策略中评估了这三种依从性情景。我们的研究结果表明，决定哪种策略最具成本效益的是绝对依从率，而不是风险依从性关系的性质。此外，概率敏感性分析表明，如果筛查的意愿支付阈值低于 60000 美元，则存在比常规筛查更具成本效益的风险分层筛查策略。
我们的研究结果表明，“不依从”会影响筛查策略的相对表现。因此，有必要包括真实的依从水平来评估个性化筛查策略，并选择最佳策略。
