Siegfrids Filip, Heinävaara Sirpa, Sarkeala Tytti, Niinikoski Laura, Laine Juha
Finnish Cancer Registry, Mäkelänkatu 2, Helsinki, 00500, Finland.
InFLAMES, University of Turku, Turku, FI-20014, Finland.
Health Econ Rev. 2025 Apr 11;15(1):35. doi: 10.1186/s13561-025-00628-5.
Within Finland's breast cancer screening program, all women aged 50-69 are invited to biennial screening. Current European guidelines recommend screening in ages 45-49 and 70-74 conditional upon, inter alia, demonstrated context-specific cost-effectiveness. This study aims to determine the cost-effectiveness of expanding the target population of biennial screening to ages 45 and/or 74, compared to the current national breast cancer screening strategy, in the Finnish setting.
Screening strategies' costs and quality-adjusted life years (QALY), aggregated over a lifetime horizon for the population simulated through a decision-analytic model, allow for comparison through incremental cost-effectiveness ratios. The model, using a Markov cohort simulation approach, was adapted to the cancer stage classification system used by the Finnish Cancer Registry (FCR) and calibrated to observed metrics in the Finnish female population. The analysis was conducted from a limited societal perspective, using a discount rate of 3% for costs and outcomes. Sensitivity analyses were performed to assess decision uncertainty, using an implicit willingness-to-pay (WTP) threshold range of €25 000-50 000 per incremental QALY.
Compared to the current national screening strategy, both strategies with a starting age of 45 were cost-effective at the WTP-threshold of €50 000 per incremental QALY. Biennial screening in ages 45-69 was also cost-effective at €25 000 per QALY and demonstrated the highest probability of cost-effectiveness of all screening strategies over the whole WTP-threshold range of €25 000-50 000 per QALY. Biennial screening in ages 50-74 was dominated by all strategies over the threshold range.
Expanding the national screening strategy target population age is likely to produce net health benefits to acceptable costs, insofar as women aged 45-49 are covered by the expansion. Only expanding the target population to age 74 is unlikely to be cost-effective, given a WTP-threshold range of €25 000-50 000 per incremental QALY.
在芬兰的乳腺癌筛查项目中，所有50至69岁的女性都被邀请参加两年一次的筛查。当前欧洲指南建议，在45至49岁以及70至74岁人群中进行筛查，尤其要视具体情况的成本效益而定。本研究旨在确定与芬兰现行的国家乳腺癌筛查策略相比，将两年一次筛查的目标人群扩大至45岁和/或74岁的成本效益。
通过决策分析模型对人群一生的筛查策略成本和质量调整生命年（QALY）进行汇总，以便通过增量成本效益比进行比较。该模型采用马尔可夫队列模拟方法，适用于芬兰癌症登记处（FCR）使用的癌症分期分类系统，并根据芬兰女性人群的观察指标进行校准。分析从有限的社会视角进行，成本和结果的贴现率为3%。进行敏感性分析以评估决策不确定性，使用的隐含支付意愿（WTP）阈值范围为每增加一个QALY 25000至50000欧元。
与当前的国家筛查策略相比，起始年龄为45岁的两种策略在每增加一个QALY支付意愿阈值为50000欧元时具有成本效益。45至69岁的两年一次筛查在每个QALY 25000欧元时也具有成本效益，并且在每个QALY 25000至50000欧元的整个WTP阈值范围内，显示出所有筛查策略中成本效益最高的可能性。50至74岁的两年一次筛查在阈值范围内被所有策略所主导。
扩大国家筛查策略目标人群年龄可能会以可接受的成本产生净健康效益，前提是45至49岁的女性被纳入扩大范围。鉴于每增加一个QALY的WTP阈值范围为25000至50000欧元，仅将目标人群扩大到7
