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Cost effectiveness of the NHS breast screening programme: life table model.

Pharoah PD, Sewell B, Fitzsimmons D, Bennett HS, Pashayan N - BMJ (2013)

Bottom Line: Probabilistic sensitivity analysis showed that this incremental cost effectiveness ratio varied widely across a range of plausible scenarios.Screening was cost effective at a threshold of £20,000 per QALY gained in 2260 (45%) scenarios, but in 588 (12%) scenarios, screening was associated with a reduction in QALYs.However, there is substantial uncertainty in the model parameter estimates, and further primary research will be needed for cost effectiveness studies to provide definitive data to inform policy.

View Article: PubMed Central - PubMed

Affiliation: Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.

ABSTRACT

Objective: To assess the overall cost effectiveness of the NHS breast screening programme, based on findings of the Independent UK Panel on Breast Cancer Screening and taking into account the uncertainty of associated estimates of benefits, harms, and costs.

Design: A life table model comparing data from two cohorts.

Setting: United Kingdom's health service.

Participants and interventions: 364,500 women aged 50 years-the population of 50 year old women in England and Wales who would be eligible for screening-were followed up for 35 years without screening, compared with a similar cohort who had regular mammographic screening between ages 50 and 70 years and were then followed for another 15 years.

Main outcome measures: Between the cohorts, we compared the number of breast cancer diagnoses, number of deaths from breast cancer, number of deaths from other causes, person years of survival adjusted for health quality, and person years of survival with breast cancer. We also calculated the costs of treating primary and end stage breast cancer, and the costs of screening. Probabilistic sensitivity analysis explored the effect of uncertainty in key input parameters on the model outputs.

Results: Under the base case scenario (using input parameters derived from the Independent Panel Review), there were 1521 fewer deaths from breast cancer and 2722 overdiagnosed breast cancers. Discounting future costs and benefits at a rate of 3.5% resulted in an additional 6907 person years of survival in the screened cohort, at a cost of 40,946 additional years of survival after a diagnosis of breast cancer. Screening was associated with 2040 additional quality adjusted life years (QALYs) at an additional cost of £42.5m (€49.8m; $64.7m) in total or £20,800 per QALY gained. The gain in person time survival over 35 years was 9.2 days per person and 2.7 quality adjusted days per person screened. Probabilistic sensitivity analysis showed that this incremental cost effectiveness ratio varied widely across a range of plausible scenarios. Screening was cost effective at a threshold of £20,000 per QALY gained in 2260 (45%) scenarios, but in 588 (12%) scenarios, screening was associated with a reduction in QALYs.

Conclusion: The NHS breast screening programme is only moderately likely to be cost effective at a standard threshold. However, there is substantial uncertainty in the model parameter estimates, and further primary research will be needed for cost effectiveness studies to provide definitive data to inform policy.

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Related in: MedlinePlus

Fig 2 Cost effectiveness acceptability curve showing probability of the screening programme being cost effective by threshold for cost effectiveness, based on 5000 runs of the probabilistic sensitivity analysis and under the assumption that screening advances diagnosis by five years during screening and results in a reduction of 10% in incidence when screening stops
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fig2: Fig 2 Cost effectiveness acceptability curve showing probability of the screening programme being cost effective by threshold for cost effectiveness, based on 5000 runs of the probabilistic sensitivity analysis and under the assumption that screening advances diagnosis by five years during screening and results in a reduction of 10% in incidence when screening stops

Mentions: Web figure 2 shows the effect of all modelled uncertainties on the primary output of incremental cost per QALY associated with the screening programme, and web figure 3 shows the distribution of the other outputs of the model. Figure 1 shows the incremental cost of screening against the change in QALYs for each of the 5000 model runs under the base case scenario for the effect of screening on breast cancer incidence. Overall, in 588 (12%) model runs, the screening programme was associated with a reduction in QALYs. In an additional 2152 (43%) runs of the model, the cost per QALY exceeded the £20 000 threshold commonly used by the National Institute for Health and Care Excellence (NICE) to determine whether an intervention should be funded through the NHS. The probability that the breast screening programme is cost effective compared with no screening was 45% (2260 scenarios) at a threshold of £20 000 per QALY. The cost per QALY exceeded £30 000 for 1944 model runs (39%) and exceeded £100 000 for 933 runs of the model (19%). Figure 2 shows the cost effectiveness acceptability curve: the probability of screening being cost effective at different thresholds for the incremental cost effectiveness ratio when all uncertainty is considered.


Cost effectiveness of the NHS breast screening programme: life table model.

Pharoah PD, Sewell B, Fitzsimmons D, Bennett HS, Pashayan N - BMJ (2013)

Fig 2 Cost effectiveness acceptability curve showing probability of the screening programme being cost effective by threshold for cost effectiveness, based on 5000 runs of the probabilistic sensitivity analysis and under the assumption that screening advances diagnosis by five years during screening and results in a reduction of 10% in incidence when screening stops
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3649817&req=5

fig2: Fig 2 Cost effectiveness acceptability curve showing probability of the screening programme being cost effective by threshold for cost effectiveness, based on 5000 runs of the probabilistic sensitivity analysis and under the assumption that screening advances diagnosis by five years during screening and results in a reduction of 10% in incidence when screening stops
Mentions: Web figure 2 shows the effect of all modelled uncertainties on the primary output of incremental cost per QALY associated with the screening programme, and web figure 3 shows the distribution of the other outputs of the model. Figure 1 shows the incremental cost of screening against the change in QALYs for each of the 5000 model runs under the base case scenario for the effect of screening on breast cancer incidence. Overall, in 588 (12%) model runs, the screening programme was associated with a reduction in QALYs. In an additional 2152 (43%) runs of the model, the cost per QALY exceeded the £20 000 threshold commonly used by the National Institute for Health and Care Excellence (NICE) to determine whether an intervention should be funded through the NHS. The probability that the breast screening programme is cost effective compared with no screening was 45% (2260 scenarios) at a threshold of £20 000 per QALY. The cost per QALY exceeded £30 000 for 1944 model runs (39%) and exceeded £100 000 for 933 runs of the model (19%). Figure 2 shows the cost effectiveness acceptability curve: the probability of screening being cost effective at different thresholds for the incremental cost effectiveness ratio when all uncertainty is considered.

Bottom Line: Probabilistic sensitivity analysis showed that this incremental cost effectiveness ratio varied widely across a range of plausible scenarios.Screening was cost effective at a threshold of £20,000 per QALY gained in 2260 (45%) scenarios, but in 588 (12%) scenarios, screening was associated with a reduction in QALYs.However, there is substantial uncertainty in the model parameter estimates, and further primary research will be needed for cost effectiveness studies to provide definitive data to inform policy.

View Article: PubMed Central - PubMed

Affiliation: Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.

ABSTRACT

Objective: To assess the overall cost effectiveness of the NHS breast screening programme, based on findings of the Independent UK Panel on Breast Cancer Screening and taking into account the uncertainty of associated estimates of benefits, harms, and costs.

Design: A life table model comparing data from two cohorts.

Setting: United Kingdom's health service.

Participants and interventions: 364,500 women aged 50 years-the population of 50 year old women in England and Wales who would be eligible for screening-were followed up for 35 years without screening, compared with a similar cohort who had regular mammographic screening between ages 50 and 70 years and were then followed for another 15 years.

Main outcome measures: Between the cohorts, we compared the number of breast cancer diagnoses, number of deaths from breast cancer, number of deaths from other causes, person years of survival adjusted for health quality, and person years of survival with breast cancer. We also calculated the costs of treating primary and end stage breast cancer, and the costs of screening. Probabilistic sensitivity analysis explored the effect of uncertainty in key input parameters on the model outputs.

Results: Under the base case scenario (using input parameters derived from the Independent Panel Review), there were 1521 fewer deaths from breast cancer and 2722 overdiagnosed breast cancers. Discounting future costs and benefits at a rate of 3.5% resulted in an additional 6907 person years of survival in the screened cohort, at a cost of 40,946 additional years of survival after a diagnosis of breast cancer. Screening was associated with 2040 additional quality adjusted life years (QALYs) at an additional cost of £42.5m (€49.8m; $64.7m) in total or £20,800 per QALY gained. The gain in person time survival over 35 years was 9.2 days per person and 2.7 quality adjusted days per person screened. Probabilistic sensitivity analysis showed that this incremental cost effectiveness ratio varied widely across a range of plausible scenarios. Screening was cost effective at a threshold of £20,000 per QALY gained in 2260 (45%) scenarios, but in 588 (12%) scenarios, screening was associated with a reduction in QALYs.

Conclusion: The NHS breast screening programme is only moderately likely to be cost effective at a standard threshold. However, there is substantial uncertainty in the model parameter estimates, and further primary research will be needed for cost effectiveness studies to provide definitive data to inform policy.

Show MeSH
Related in: MedlinePlus