The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria
| Autor: | Christoph Urach, Uwe Siebert, Irmgard Schiller-Fruehwirth, G. Zauner, Patrick Einzinger, Beate Jahn |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Cost effectiveness Cost-Benefit Analysis Breast Neoplasms 03 medical and health sciences Breast cancer screening 0302 clinical medicine Breast cancer Health care medicine Humans Mass Screening 030212 general & internal medicine Early Detection of Cancer health care economics and organizations Mass screening Aged Actuarial science medicine.diagnostic_test Cost–benefit analysis business.industry Health Policy Uncertainty Public Health Environmental and Occupational Health Health Care Costs Cost-effectiveness analysis Middle Aged medicine.disease Quality-adjusted life year Austria 030220 oncology & carcinogenesis Female Quality-Adjusted Life Years business Mammography Demography |
| Zdroj: | Value in Health. 20:1048-1057 |
| ISSN: | 1098-3015 |
| Popis: | Background In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. Objectives To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. Methods We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Results Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. Conclusions The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria. |
| Databáze: | OpenAIRE |
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