Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?

Robert Morton,1,2 Meelad Sayma,1,3 Manraj Singh Sura,1,4 1Imperial College Business School, Imperial College London, London, 2Department of Medicine, University of Aberdeen, Aberdeen, 3Knowledge Spa, Peninsula College of Medicine and Dentistry, Truro, 4Department of Medicine, University of Birmingha...

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Autores principales:	Morton R, Sayma M, Sura MS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Breast Cancer Screening Cost-effectiveness Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/64cd12a80f3244acb7830e873d29909f
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spelling	oai:doaj.org-article:64cd12a80f3244acb7830e873d29909f2021-12-02T04:34:03ZEconomic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?1179-1314https://doaj.org/article/64cd12a80f3244acb7830e873d29909f2017-03-01T00:00:00Zhttps://www.dovepress.com/economic-analysis-of-the-breast-cancer-screening-program-used-by-the-u-peer-reviewed-article-BCTThttps://doaj.org/toc/1179-1314Robert Morton,1,2 Meelad Sayma,1,3 Manraj Singh Sura,1,4 1Imperial College Business School, Imperial College London, London, 2Department of Medicine, University of Aberdeen, Aberdeen, 3Knowledge Spa, Peninsula College of Medicine and Dentistry, Truro, 4Department of Medicine, University of Birmingham, Birmingham, UK Introduction: One key tool thought to combat the spiraling costs of late-stage breast cancer diagnosis is the use of breast cancer screening. However, over recent years, more effective treatments and questions being raised over the safety implications of using mammography have led to the cost-effectiveness of breast cancer screening to be highlighted as an important issue to investigate. Methods: A cost–utility analysis was conducted to appraise the breast cancer screening program. The analysis considered the breast cancer screening program and its utility over a 20-year period, accounting for the typical breast cancer screening period taking place between the ages of 50 and 70 years. Analysis was conducted from the perspective of the UK National Health Service (NHS). This accepted NHS threshold was utilized for analysis of £20,000/quality-adjusted life year (QALY)–£30,000/QALY gain. A systematic literature review was conducted to obtain relevant financial, health, and probability outcomes pertaining to the breast cancer screening program. Results: The mean incremental cost-effectiveness ratio (ICER) calculated was at a value of £11,546.11 with subsequent sensitivity analysis conducted around this value. Three sensitivity analyses were undertaken to evaluate ICERs of a range of scenarios which could occur as the following: 1) maximum costs at each node – £17,254/QALY; 2) all costs are fixed costs: screening center costs, and staff are paid for regardless of use – £14,172/QALY; and 3) combination of (1) and (2) to produce a worst case scenario £20,823/QALY. Discussion and conclusion: The majority of calculations suggested that breast cancer screening is cost-effective. However, in our worst case scenario, the ICER fell near the bottom ceiling ratio. This makes it unclear whether the program should be available in the future, as more evidence becomes available over the risks of screening and as some currently expensive chemotherapy drugs begin to lose patents. Keywords: breast cancer, screening, cost-effectiveness, economic analysisMorton RSayma MSura MSDove Medical PressarticleBreast CancerScreeningCost-effectivenessNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 9, Pp 217-225 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Breast Cancer Screening Cost-effectiveness Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Breast Cancer Screening Cost-effectiveness Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Morton R Sayma M Sura MS Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?
description	Robert Morton,1,2 Meelad Sayma,1,3 Manraj Singh Sura,1,4 1Imperial College Business School, Imperial College London, London, 2Department of Medicine, University of Aberdeen, Aberdeen, 3Knowledge Spa, Peninsula College of Medicine and Dentistry, Truro, 4Department of Medicine, University of Birmingham, Birmingham, UK Introduction: One key tool thought to combat the spiraling costs of late-stage breast cancer diagnosis is the use of breast cancer screening. However, over recent years, more effective treatments and questions being raised over the safety implications of using mammography have led to the cost-effectiveness of breast cancer screening to be highlighted as an important issue to investigate. Methods: A cost–utility analysis was conducted to appraise the breast cancer screening program. The analysis considered the breast cancer screening program and its utility over a 20-year period, accounting for the typical breast cancer screening period taking place between the ages of 50 and 70 years. Analysis was conducted from the perspective of the UK National Health Service (NHS). This accepted NHS threshold was utilized for analysis of £20,000/quality-adjusted life year (QALY)–£30,000/QALY gain. A systematic literature review was conducted to obtain relevant financial, health, and probability outcomes pertaining to the breast cancer screening program. Results: The mean incremental cost-effectiveness ratio (ICER) calculated was at a value of £11,546.11 with subsequent sensitivity analysis conducted around this value. Three sensitivity analyses were undertaken to evaluate ICERs of a range of scenarios which could occur as the following: 1) maximum costs at each node – £17,254/QALY; 2) all costs are fixed costs: screening center costs, and staff are paid for regardless of use – £14,172/QALY; and 3) combination of (1) and (2) to produce a worst case scenario £20,823/QALY. Discussion and conclusion: The majority of calculations suggested that breast cancer screening is cost-effective. However, in our worst case scenario, the ICER fell near the bottom ceiling ratio. This makes it unclear whether the program should be available in the future, as more evidence becomes available over the risks of screening and as some currently expensive chemotherapy drugs begin to lose patents. Keywords: breast cancer, screening, cost-effectiveness, economic analysis
format	article
author	Morton R Sayma M Sura MS
author_facet	Morton R Sayma M Sura MS
author_sort	Morton R
title	Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?
title_short	Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?
title_full	Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?
title_fullStr	Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?
title_full_unstemmed	Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?
title_sort	economic analysis of the breast cancer screening program used by the uk nhs: should the program be maintained?
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/64cd12a80f3244acb7830e873d29909f
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Economic analysis of the breast cancer screening program used by the UK NHS: should the program be maintained?

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