Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Value Health. 2021 Mar;24(3):353-360. doi: 10.1016/j.jval.2020.10.018. Epub 2021 Jan 25.
To quantify the impact of mammography-based screening on the quality of life, disability-adjusted life years (DALYs) averted or quality-adjusted life years (QALYs) gained can be used. We aimed to assess whether the use of DALYs averted or QALYs gained will lead to different cost-effective screening strategies.
Using the microsimulation model MISCAN, we simulated different breast cancer screening strategies varying in starting age (starting at 45, 47, and 50 years), stopping age (stopping at 69, 72, and 74 years), and frequency (annual [A], biennial [B], combination of both [A + B], and triennial [T]). In total, we defined 24 different breast cancer screening strategies, including no screening as a reference strategy. We calculated incremental cost-effectiveness ratios (ICERs) and compared which strategies were on the efficiency frontiers for DALYs and QALYs.
Breast cancer screening averted between 46.00 and 105.58 DALYs and gained between 28.69 and 64.50 QALYs per 1000 women. For DALYs there were 5 strategies on the efficiency frontier (T50-69, T50-74, T45-74, B45-74, and A45-74). The same strategies plus one (B45-72) were on the efficiency frontier for QALYs.
Using DALYs averted instead of QALYs gained to assess the effects on quality of life from breast cancer screening in the Dutch population yields differences in ICERs, but almost the same strategies were on the efficiency frontiers. Whether the choice in outcome measure leads to a difference in optimal policy depends on the cost-effectiveness threshold.
可以使用基于乳房 X 线照片筛查的质量调整生命年（DALY）避免量或质量调整生命年（QALY）获益来量化对生活质量的影响。我们旨在评估 DALY 避免量或 QALY 获益的使用是否会导致不同的具有成本效益的筛查策略。
使用微模拟模型 MISCAN，我们模拟了不同的乳腺癌筛查策略，其起始年龄（起始于 45、47 和 50 岁）、停止年龄（停止于 69、72 和 74 岁）和频率（每年[A]、每两年[B]、两者的组合[A+B]和每三年[T]）不同。总共，我们定义了 24 种不同的乳腺癌筛查策略，包括不筛查作为参考策略。我们计算了增量成本效益比（ICER），并比较了 DALY 和 QALY 中哪些策略处于效率前沿。
乳腺癌筛查避免了 46.00 至 105.58 个 DALY，并使每 1000 名妇女获得了 28.69 至 64.50 个 QALY。对于 DALY，有 5 种策略处于效率前沿（T50-69、T50-74、T45-74、B45-74 和 A45-74）。同样的策略再加上一种（B45-72）也是 QALY 的效率前沿。
在荷兰人群中使用 DALY 避免量而不是 QALY 获益来评估乳腺癌筛查对生活质量的影响会导致 ICER 的差异，但几乎相同的策略处于效率前沿。选择结果衡量标准是否会导致最佳政策的差异取决于成本效益阈值。
