Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Value Health. 2019 Feb;22(2):185-193. doi: 10.1016/j.jval.2018.07.880. Epub 2018 Sep 8.
Several specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016.
To evaluate the cost-effectiveness of US-based mammography screening guidelines.
We developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier.
The screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older.
The screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system's investment in the early detection and treatment of breast cancer.
几家专业学会最近在 2015 年末/2016 年初更新了他们的乳腺癌筛查指南。
评估美国基于乳腺 X 线筛查指南的成本效益。
我们开发了一个微观模拟模型来生成浸润性乳腺癌的自然史，并捕捉筛查和治疗如何改变疾病的自然进程。我们使用该模型评估了筛查策略的成本效益，包括从 40 岁开始每年进行筛查、从 50 岁开始每两年进行筛查，以及一种混合策略，即从 45 岁开始筛查，在 55 岁时转为每两年筛查，结合三种终止年龄：75 岁、80 岁和无上限年龄。结果以增量成本效益比（每质量调整生命年的成本[QALY]）和成本效益可接受性前沿表示。
从 45 岁开始每年进行乳腺 X 线检查，然后在 55 岁至 75 岁之间切换为每两年进行一次检查的筛查策略最具成本效益，增量成本效益比为 40135 美元/QALY。概率分析表明，当社会意愿支付介于 44000 美元/QALY 和 103500 美元/QALY 之间时，混合策略具有最高的最优概率。在社会普遍接受的支付意愿范围内，没有最佳策略涉及 80 岁或以上的筛查终止年龄。
对于平均风险女性而言，基于混合设计的筛查策略最具成本效益。通过在制定建议时考虑收益和危害之间的平衡，这种混合筛查策略有可能优化医疗保健系统在早期发现和治疗乳腺癌方面的投资。
