Boer R, de Koning H, Threlfall A, Warmerdam P, Street A, Friedman E, Woodman C
Department of Public Health, Instituut Maatschappelijke Gezondheidszorg, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands.
BMJ. 1998 Aug 8;317(7155):376-9. doi: 10.1136/bmj.317.7155.376.
To compare the cost effectiveness of two possible modifications to the current UK screening programme: shortening the screening interval from three to two years and extending the age of invitation to a final screen from 64 to 69.
Computer simulation model which first simulates life histories for women in the absence of a screening programme for breast cancer and then assesses how these life histories would be changed by introducing different screening policies. The model was informed by screening and cost data from the NHS breast screening programme.
North West region of England.
Numbers of deaths prevented, life years gained, and costs.
Compared with the current breast screening programme both modifications would increase the number of deaths prevented and the number of life years saved. The current screening policy costs 2522 pounds per life year gained; extending the age range of the programme would cost 2612 pounds and shortening the interval 2709 pounds per life year gained. The marginal cost per life year gained of extending the age range of the screening programme is 2990 pounds and of shortening the screening interval is 3545 pounds.
If the budget for the NHS breast screening programme were to allow for two more invitations per woman, substantial mortality reductions would follow from extending the age range screened or reducing the screening interval. The difference between the two policies is so small that either could be chosen.
比较对当前英国筛查计划的两种可能修改方案的成本效益：将筛查间隔从三年缩短至两年，以及将最终筛查的邀请年龄从64岁延长至69岁。
计算机模拟模型，该模型首先模拟在没有乳腺癌筛查计划的情况下女性的生命历程，然后评估引入不同的筛查政策会如何改变这些生命历程。该模型依据英国国家医疗服务体系乳腺癌筛查计划的筛查和成本数据构建。
英格兰西北部地区。
预防的死亡人数、获得的生命年数和成本。
与当前的乳腺癌筛查计划相比，这两种修改方案都将增加预防的死亡人数和挽救的生命年数。当前的筛查政策每获得一个生命年的成本为2522英镑；扩大筛查计划的年龄范围每获得一个生命年的成本为2612英镑，缩短筛查间隔每获得一个生命年的成本为2709英镑。扩大筛查计划年龄范围每获得一个生命年的边际成本为2990英镑，缩短筛查间隔的边际成本为3545英镑。
如果英国国家医疗服务体系乳腺癌筛查计划的预算允许每位女性多接受两次邀请，那么扩大筛查年龄范围或缩短筛查间隔都将大幅降低死亡率。这两种政策之间的差异非常小，选择哪种都可以。
