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, Uwe Siebert*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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.

Original languageEnglish
Pages (from-to)1311-1344
Number of pages34
JournalEuropean Journal of Health Economics
Volume22
Issue number8
DOIs
Publication statusPublished - Nov 2021

Bibliographical note

Funding Information:
This study is part of the FORECEE (4C) project funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement number 634570 and The Eve Appeal.

Funding Information:
Dr. Mühlberger, Dr. Sroczynski, MD Gogollari, Dr. Jahn, Dr. Pashayan, Prof. Steyerberg, Prof. Widschwendter, and Prof. Siebert report grants from European Union’s Horizon 2020 research and innovation programme (grant agreement number 634570) during the conduct of the study. Dr. Pashayan also reports research grant from Breast Cancer Now (grant reference number 20l7NovPRl 0241). Ms. Gogollari was partly funded by the Erasmus-Western Balkans mobility programme (ERAWEB), a project funded by the European Commission. The authors declare no other potential conflicts of interest.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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