Objectives
The objective of this literature review was to explore the existing evidences regarding cost-effectiveness of breast cancer screening (BCS) tests in average-risk women and in high-risk women.
Methods
A literature review was performed using the PICO method: Population consisted of women at average risk and at high risk for breast cancer; Intervention and Comparators were BCS tests, and Outcomes were incremental cost-effectiveness ratios (ICERs). The literature search was performed with the NHS EED filters using the electronic databases (MEDLINE, EMBASE and PubMed) from January 2005 until May 2015.
Results
The literature review allowed retrieving 1,699 studies of which 39 fulfilled the eligibility criteria. Fourteen studies were cost-effectiveness analyses, twenty-one were cost-utility analyses and four were both. Eighteen studies used a Markov model while seven studies used a decision tree. Time horizon varied from 5 years to lifetime. Main interventions compared were no screening, biennial mammography, annual mammography and annual mammography combined to MRI. For average-risk women, ICERs for biennial mammography varied between (2015US)$4,715-$21,747/LYG and between (2015US)$7,548-$107,590/QALY compared to no screening, while ICERs for annual mammography ranged from (2015US)$24,124-$40,266/LYG and (2015US)$69,217/QALY. For high-risk women, ICERs for annual mammography ranged from (2015US)$7,221-$39,251/QALY compared to no screening. Also for high-risk women, combined MRI and mammography were associated with ICERs from (2015US)$19,288/QALY to dominant compared to mammography alone. These results include women of any age and mammography of any type.
Conclusions
Results suggest that annual mammography is mostly cost-effective when compared to no screening. According to a $100,000/QALY threshold, most of analyzed studies suggest that combined screening is cost-effective in high-risk women compared to mammography alone, despite a wide cost-effectiveness ratios range. Notwithstanding the high level of heterogeneity among selected studies, this review provides a comprehensive overview of the cost-effectiveness of BCS and could serve in the realization of future economic evaluations.
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