Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England.
Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.
Bull World Health Organ. 2018 Aug 1;96(8):568-577. doi: 10.2471/BLT.18.207944. Epub 2018 Jun 28.
To model the cost-effectiveness of a risk-based breast cancer screening programme in urban China, launched in 2012, compared with no screening.
We developed a Markov model to estimate the lifetime costs and effects, in terms of quality-adjusted life years (QALYs), of a breast cancer screening programme for high-risk women aged 40-69 years. We derived or adopted age-specific incidence and transition probability data, assuming a natural history progression between the stages of cancer, from other studies. We obtained lifetime direct and indirect treatment costs in 2014 United States dollars (US$) from surveys of breast cancer patients in 37 Chinese hospitals. To calculate QALYs, we derived utility scores from cross-sectional patient surveys. We evaluated incremental cost-effectiveness ratios for various scenarios for comparison with a willingness-to-pay threshold.
Our baseline model of annual screening yielded an incremental cost-effectiveness ratio of US$ 8253/QALY, lower than the willingness-to-pay threshold of US$ 23 050/QALY. One-way and probabilistic sensitivity analyses demonstrated that the results are robust. In the exploration of various scenarios, screening every 3 years is the most cost-effective with an incremental cost-effectiveness ratio of US$ 6671/QALY. The cost-effectiveness of the screening is reduced if not all diagnosed women seek treatment. Finally, the economic benefit of screening women aged 45-69 years with both ultrasound and mammography, compared with mammography alone, is uncertain.
High-risk population-based breast cancer screening is cost-effective compared with no screening.
针对 2012 年在中国城市启动的基于风险的乳腺癌筛查项目，构建一个成本效益模型，与不进行筛查进行比较。
我们开发了一个马尔可夫模型，以估计年龄在 40-69 岁的高风险女性乳腺癌筛查计划的终身成本和效果，即质量调整生命年（QALY）。我们从其他研究中得出或采用了特定年龄的发病率和转移概率数据，假设癌症各阶段之间存在自然病史进展。我们从 37 家中国医院的乳腺癌患者调查中获得了 2014 年的直接和间接治疗成本。为了计算 QALY，我们从横断面患者调查中得出了效用评分。我们评估了各种方案的增量成本效益比，以便与意愿支付阈值进行比较。
我们的年度筛查基线模型的增量成本效益比为 8253 美元/QALY，低于 23050 美元/QALY 的意愿支付阈值。单因素和概率敏感性分析表明结果是稳健的。在对各种方案的探索中，每 3 年筛查一次具有成本效益，增量成本效益比为 6671 美元/QALY。如果不是所有诊断出的女性都寻求治疗，筛查的成本效益就会降低。最后，与单独使用乳房 X 光摄影相比，使用超声和乳房 X 光摄影筛查 45-69 岁女性的成本效益是不确定的。
与不进行筛查相比，基于风险的人群乳腺癌筛查具有成本效益。
