Seung Soo-Jin, Mittmann Nicole, Ante Zharmaine, Liu Ning, Blackmore Kristina M, Richard Emilie S, Wong Anisia, Walker Meghan J, Earle Craig C, Simard Jacques, Chiarelli Anna M
HOPE Research Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Cancers (Basel). 2024 Sep 18;16(18):3189. doi: 10.3390/cancers16183189.
A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada.
From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs.
For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56-64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676).
Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.
在加拿大安大略省开展的“PERSPECTIVE I&I项目”中进行了一项前瞻性队列研究，以评估与乳腺癌风险评估和筛查相关的医疗资源利用及成本，以及按风险水平分层的总体成本。
2019年7月至2022年12月，1997名年龄在50至70岁之间的女性在安大略省同意进行风险评估，并获得了她们的乳腺癌风险水平和个性化筛查行动计划。风险分层筛查相关活动的平均成本包括风险评估、筛查和诊断成本。临床评估科学研究所（ICES）的GETCOST宏程序评估了医疗系统的平均总体成本。
对于1997名参与者，估计分别有83.3%、14.4%和2.3%为平均风险、高于平均风险和高风险（年龄中位数（四分位间距）：60 [56 - 64]岁）。使用经过验证的多因素CanRisk预测工具将其分为三个风险水平，该工具包括家族史信息、多基因风险评分（PRS）、乳腺密度以及既定的生活方式/激素风险因素。每位个体的遗传咨询就诊次数、乳房X光检查次数和核磁共振成像（MRI）次数的平均值随风险水平增加。2022年，高风险参与者的总体平均风险分层筛查相关成本最高，为905加元（±标准差269加元），高于平均风险参与者为580加元（±192加元），平均风险参与者为521加元（±163加元）。在与乳房筛查相关的成本中，所有风险组中最大的成本负担是风险评估成本，其次是总诊断和筛查成本。每位参与者的平均总体医疗成本（±标准差），平均风险参与者最高，为6311加元（±19,641加元），高于平均风险参与者为5391加元（±8325加元），高风险参与者为5169加元（±7676加元）。
尽管高风险参与者的风险分层筛查相关成本最高，但他们的总体医疗利用成本与其他风险水平相似。我们的研究强调了将风险分层作为筛查途径的一部分的重要性，以支持在更早且更易治疗的阶段检测乳腺癌，从而降低成本和医疗系统的总体负担。
