Disability-Adjusted Life Years Averted Versus Quality-Adjusted Life Years Gained: A Model Analysis for Breast Cancer Screening

Masa Davidovic, Nadine Zielonke, Iris Lansdorp - Vogelaar, N Segnan, Harry de Koning, Eveline Heijnsdijk

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


Objectives: To quantify the impact of mammography-based screening on the quality of life, disability-adjusted life years (DALYs) averted or quality-adjusted life years (QALYs) gained can be used. We aimed to assess whether the use of DALYs averted or QALYs gained will lead to different cost-effective screening strategies. Methods: Using the microsimulation model MISCAN, we simulated different breast cancer screening strategies varying in starting age (starting at 45, 47, and 50 years), stopping age (stopping at 69, 72, and 74 years), and frequency (annual [A], biennial [B], combination of both [A + B], and triennial [T]). In total, we defined 24 different breast cancer screening strategies, including no screening as a reference strategy. We calculated incremental cost-effectiveness ratios (ICERs) and compared which strategies were on the efficiency frontiers for DALYs and QALYs. Results: Breast cancer screening averted between 46.00 and 105.58 DALYs and gained between 28.69 and 64.50 QALYs per 1000 women. For DALYs there were 5 strategies on the efficiency frontier (T50-69, T50-74, T45-74, B45-74, and A45-74). The same strategies plus one (B45-72) were on the efficiency frontier for QALYs. Conclusions: Using DALYs averted instead of QALYs gained to assess the effects on quality of life from breast cancer screening in the Dutch population yields differences in ICERs, but almost the same strategies were on the efficiency frontiers. Whether the choice in outcome measure leads to a difference in optimal policy depends on the cost-effectiveness threshold.

Original languageEnglish
Pages (from-to)353-360
Number of pages8
JournalValue in Health
Issue number3
Publication statusPublished - Mar 2021

Bibliographical note

Funding Information:
Funding/Support: This work was funded by the EU-Framework Programme (Horizon 2020) of the European Commission [project reference 634753] and supported by the National Institute for Public Health and the Environment.

Publisher Copyright:
© 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research


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