Pashayan N, et al. - In this cost-effectiveness study, researchers investigated the benefit-to-harm ratio and the cost-effectiveness of risk-stratified breast screening programs vs a standard age-based screening program and no screening. According to findings, adoption of a risk-stratified screening strategy may improve the cost-effectiveness and the benefit-to-harm ratio of breast screening programs.

Methods

• Researchers used the following to create a life-table model of a hypothetical cohort of 364,500 women in the United Kingdom, aged 50 years, with follow-up to age 85 years: findings of the Independent UK Panel on Breast Cancer Screening and risk distribution based on polygenic risk profile.
• They undertook the analysis from the National Health Service perspective.
• The modeled interventions included: no screening, age-based screening (mammography screening every 3 years from age 50-69 years), and risk-stratified screening (a proportion of women aged 50 years with a risk score greater than a threshold risk were offered screening every 3 years until age 69 years) considering each percentile of the risk distribution.
• Between July 2016 and September 2017, they performed all analyses.
• They assessed overdiagnoses, breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, costs in British pounds, and net monetary benefit (NMB) as main outcome measures.
• Using probabilistic sensitivity analyses, they ascertained uncertainty around parameter estimates.
• They discounted future costs and benefits at 3.5% per year.

Results

• Researchers included a hypothetical cohort of 364,500 women followed up from age 50-85 years, in the risk-stratified analysis of this life-table model.
• On lowering the risk threshold, a linear increase in the incremental cost of the program was noted when compared with no screening, with no additional QALYs gained below the 35th percentile risk threshold.
• The highest NMB was noted with the risk-stratified scenario, with risk threshold at the 70th percentile among the three screening scenarios, at a willingness to pay of £20 000 (US $26 800) per QALY gained, with a 72% probability of being cost-effective.
• At the 32nd percentile vs 70th percentile risk threshold, risk-stratified screening would cost £20 066 (US $26 888) vs £537 985 (US $720 900) less, would have 26.7% vs 71.4% fewer overdiagnoses, and would avert 2.9% vs 9.6% fewer breast cancer deaths, respectively, when compared with age-based screening.