Risk-Stratified Breast Cancer Screening Ups Cost-Effectiveness

FRIDAY, July 6, 2018 — Risk-stratified breast screening improves the cost-effectiveness of screening, according to a study published online July 5 in JAMA Oncology.

Nora Pashayan, M.D., Ph.D., from University College London, and colleagues used findings of the Independent U.K. Panel on Breast Cancer Screening and risk distribution based on polygenic risk profile 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 85 years. The modeled interventions were no screening, age-based screening, and risk-stratified screening.

The researchers found that the incremental cost of the program increased linearly compared with no screening as the risk threshold was lowered; no additional quality-adjusted life-years (QALYs) were gained below the 35th percentile risk threshold. The highest net monetary benefit was seen for the risk-stratified screening scenario with risk threshold at the 70th percentile, at a willingness to pay of $26,800 per QALY gained; the probability of being cost-effective was 72 percent. Risk-stratified screening at the 32nd versus the 70th percentile risk threshold would cost $26,888 versus $720,900 less, would result in 26.7 versus 71.4 percent fewer overdiagnoses, and would avert 2.9 versus 9.6 percent fewer breast cancer deaths relative to age-based screening.

“Not offering breast cancer screening to women at lower risk could improve the cost-effectiveness of the screening program, reduce overdiagnosis, and maintain the benefits of screening,” the authors write.

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Posted: July 2018

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