Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Cancer. 2022 Jul 15;151(2):287-296. doi: 10.1002/ijc.34000. Epub 2022 Mar 21.
Breast cancer screening policies have been designed decades ago, but current screening strategies may not be optimal anymore. Next to that, screening capacity issues may restrict feasibility. This cost-effectiveness study evaluates an extensive set of breast cancer screening strategies in the Netherlands. Using the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model, the cost-effectiveness of 920 breast cancer screening strategies with varying starting ages (40-60), stopping ages (64-84) and intervals (1-4 years) were simulated. The number of quality adjusted life years (QALYs) gained and additional net costs (in €) per 1000 women were predicted (3.5% discounted) and incremental cost-effectiveness ratios (ICERs) were calculated to compare screening scenarios. Sensitivity analyses were performed using different assumptions. In total, 26 strategies covering all four intervals were on the efficiency frontier. Using a willingness-to-pay threshold of €20 000/QALY gained, the biennial 40 to 76 screening strategy was optimal. However, this strategy resulted in more overdiagnoses and false positives, and required a high screening capacity. The current strategy in the Netherlands, biennial 50 to 74 years, was dominated. Triennial screening in the age range 44 to 71 (ICER 9364) or 44 to 74 (ICER 11144) resulted in slightly more QALYs gained and lower costs than the current Dutch strategy. Furthermore, these strategies were estimated to require a lower screening capacity. Findings were robust when varying attendance and effectiveness of treatment. In conclusion, switching from biennial to triennial screening while simultaneously lowering the starting age to 44 can increase benefits at lower costs and with a minor increase in harms compared to the current strategy.
乳腺癌筛查政策是几十年前制定的，但目前的筛查策略可能已经不再最优。此外，筛查能力问题可能会限制其可行性。本项成本效益研究评估了荷兰广泛的乳腺癌筛查策略。使用 Microsimulation Screening Analysis-Breast (MISCAN-Breast) 模型，模拟了 920 种不同起始年龄（40-60 岁）、停止年龄（64-84 岁）和间隔（1-4 年）的乳腺癌筛查策略的成本效益。预测了每 1000 名女性获得的质量调整生命年（QALYs）和额外的净成本（€）（贴现率为 3.5%），并计算了增量成本效益比（ICER）以比较筛查方案。使用不同的假设进行了敏感性分析。总共 26 种涵盖所有四个间隔的策略处于效率边界。使用获得的每 QALY 20,000€的意愿支付阈值，每两年进行一次 40 至 76 岁的筛查策略是最佳的。然而，这种策略会导致更多的过度诊断和假阳性，并需要较高的筛查能力。荷兰目前的策略，每两年对 50-74 岁的女性进行筛查，处于劣势。44-71 岁（ICER 9364）或 44-74 岁（ICER 11144）每三年进行一次筛查，获得的 QALYs 略多，成本略低，比荷兰现行策略更优。此外，这些策略估计需要较低的筛查能力。当改变治疗的参与率和效果时，研究结果仍然稳健。总之，与现行策略相比，将筛查间隔从两年改为三年，同时将起始年龄降低到 44 岁，可以在增加获益的同时降低成本，并略微增加危害。
