Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies

Nikolai Mühlberger, Gaby Sroczynski, Artemisa Gogollari, Beate Jahn, Nora Pashayan, Ewout Steyerberg, Martin Widschwendter and Uwe Siebert ()
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Nikolai Mühlberger: UMIT–University for Health Sciences, Medical Informatics and Technology
Gaby Sroczynski: UMIT–University for Health Sciences, Medical Informatics and Technology
Artemisa Gogollari: UMIT–University for Health Sciences, Medical Informatics and Technology
Beate Jahn: UMIT–University for Health Sciences, Medical Informatics and Technology
Nora Pashayan: UCL–University College London
Ewout Steyerberg: Erasmus MC
Martin Widschwendter: EGA Institute for Women’s Health, UCL - University College London
Uwe Siebert: UMIT–University for Health Sciences, Medical Informatics and Technology

The European Journal of Health Economics, 2021, vol. 22, issue 8, No 12, 1344 pages

Abstract: Abstract Objectives Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost–benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. Methods Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. Results Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. Conclusions Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.

Keywords: Breast cancer screening; Breast cancer prevention; Cost effectiveness; Decision analysis; Risk stratification; Overdiagnosis (search for similar items in EconPapers)
Date: 2021
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DOI: 10.1007/s10198-021-01338-5

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