Khan Shah Alam, Hernandez-Villafuerte Karla Vanessa, Muchadeyi Muchandifunga Trust, Schlander Michael
Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Int J Cancer. 2021 Apr 12. doi: 10.1002/ijc.33593.
To analyse published evidence on the economic evaluation of risk-based screening (RBS), a full systematic literature review was conducted. After a quality appraisal, we compared the cost-effectiveness of risk-based strategies (low-risk, medium-risk and high-risk) with no screening and age-based screening. Studies were also analysed for modelling, risk stratification methods, input parameters, data sources and harms and benefits. The 10 modelling papers analysed were based on screening performance of film-based mammography (FBM) (three); digital mammography (DM) and FBM (two); DM alone (three); DM, ultrasound (US) and magnetic resonance imaging (one) and DM and US (one). Seven studies did not include the cost of risk-stratification, and one did not consider the cost of diagnosis. Disutility was incorporated in only six studies (one for screening and five for diagnosis). None of the studies reported disutility of risk-stratification (being considered as high-risk). Risk-stratification methods varied from only breast density (BD) to the combination of familial risk, genetic susceptibility, lifestyle, previous biopsies, Jewish ancestry and reproductive history. Less or no screening in low-risk women and more frequent mammography screening in high-risk women was more cost-effective compared to no screening and age-based screening. High-risk women screened annually yielded a higher mortality rate reduction and more quality-adjusted life years at the expense of higher cost and false positives. RBS can be cost effective compared to the alternatives. However, heterogeneity among risk-stratification methods, input parameters, and weaknesses in the methodologies hinder the derivation of robust conclusions. Therefore, further studies are warranted to assess newer technologies and innovative risk-stratification methods.
为分析已发表的关于基于风险的筛查（RBS）经济评估的证据，我们进行了全面的系统文献综述。在进行质量评估后，我们将基于风险的策略（低风险、中风险和高风险）与不进行筛查和基于年龄的筛查的成本效益进行了比较。还对研究的建模、风险分层方法、输入参数、数据来源以及危害和益处进行了分析。所分析的10篇建模论文基于以下筛查方式：基于胶片的乳腺X线摄影（FBM）（3篇）；数字乳腺X线摄影（DM）和FBM（2篇）；单独的DM（3篇）；DM、超声（US）和磁共振成像（1篇）以及DM和US（1篇）。7项研究未纳入风险分层的成本，1项研究未考虑诊断成本。仅6项研究纳入了负效用（1项用于筛查，5项用于诊断）。没有研究报告风险分层（被视为高风险）的负效用。风险分层方法从仅使用乳腺密度（BD）到家族风险、遗传易感性、生活方式、既往活检、犹太血统和生殖史的组合各不相同。与不进行筛查和基于年龄的筛查相比，低风险女性进行较少或不进行筛查，高风险女性进行更频繁的乳腺X线摄影筛查更具成本效益。每年接受筛查的高风险女性死亡率降低更高，质量调整生命年更多，但代价是成本更高和假阳性更多。与其他替代方案相比，RBS可能具有成本效益。然而，风险分层方法、输入参数之间的异质性以及方法学上的弱点阻碍了得出可靠的结论。因此，有必要进行进一步研究以评估更新的技术和创新的风险分层方法。
