Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study

BMJ 1998;317:376-379 ( 8 August )

Papers

Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study

See p 388 and Editorial by Werneke and McPherson

Rob Boer, informatician, ^a Harry de Koning, assistant professor, ^a Anthony Threlfall, research officer, ^b Peter Warmerdam, econometrist, ^a Andrew Street, senior research fellow, ^c Ellis Friedman, director of public health, ^d Ciaran Woodman, director. ^b

^a Department of Public Health, Instituut Maatschappelijke Gezondheidszorg, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands, ^b Centre for Cancer Epidemiology, University of Manchester, Manchester M20 4QL, ^c York Health Economics Consortium, University of York, York YO1 5DD, ^d Department of Public Health Medicine, West Pennine Health Authority, Oldham OL1 2PN

Correspondence to: Dr Boer boer{at}mgz.fgg.eur.nl

Objective: To compare the cost effectiveness of two possible modifications to the current UK screening programme: shorteningthe screening interval from three to two years and extending theage of invitation to a final screen from 64 to 69.
Design: Computer simulation model which first simulates life histories for women in the absence of a screening programmefor breast cancer and then assesses how these life histories wouldbe changed by introducing different screening policies. The model was informed by screening and cost data from the NHS breast screening programme.
Setting: North West region of England.
Main outcome measures: Numbers of deaths prevented, life years gained, and costs.
Results: Compared with the current breast screening programme both modifications would increase the number of deaths prevented and the number of life years saved. The current screening policy costs £2522 per life year gained; extending the age rangeof the programme would cost £2612 and shortening the interval£2709 per life year gained. The marginal cost per life year gainedof extending the age range of the screening programme is £2990and of shortening the screening interval is £3545.
Conclusions: If the budget for the NHS breast screening programme were to allow for two more invitations per woman, substantial mortality reductions would follow from extending theage range screened or reducing the screening interval. The difference between the two policies is so small that either could be chosen.

Key messages

Computer modelling suggested that the current breast screening programme in North West England will reduce total female breast cancer mortality by 12.8%
Extending the programme to age 69 would reduce mortality by 16.4% at a marginal cost per life year saved of £2990 while reducing the interval to two years would reduce mortality by 15.3% at a marginal cost per life year saved of £3545
Extending the age range prevents more deaths from breast cancer but shortening the interval gains more life years
If the budget for the NHS breast screening programme would allow for two more invitations per woman either of the two options could be chosen

© BMJ 1998

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

NHS breast screening programme: Heather Goodare, Margaret King, Michael Baum, Ann Johnson, Jane Shekhdar, N E Day, Rob Boer, Harry de Koning, Anthony Threlfall, Ciaran Woodman, Andrew Street, and Ellis Friedman
BMJ 1999 318: 397. [Extract] [Full Text]

Extending the boundaries
BMJ 1998 317: 0. [Full Text]

Extending the boundaries
BMJ 1998 317: 0. [Full Text]

Two more screens per woman would improve effectiveness of UK breast cancer screening
BMJ 1998 317: 0. [Full Text]

Extending the benefits of breast cancer screening: Ursula Werneke and Klim McPherson
BMJ 1998 317: 360-361. [Extract] [Full Text]

Routine invitation of women aged 65-69 for breast cancer screening: results of first year of pilot study: Gary Rubin, Linda Garvican, and Sue Moss
BMJ 1998 317: 388-389. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Ahern, C. H., Shen, Y. (2009). Cost-Effectiveness Analysis of Mammography and Clinical Breast Examination Strategies: A Comparison with Current Guidelines. Cancer Epidemiol. Biomarkers Prev. 18: 718-725 [Abstract] [Full text]
Sihto, H., Lundin, J., Lehtimaki, T., Sarlomo-Rikala, M., Butzow, R., Holli, K., Sailas, L., Kataja, V., Lundin, M., Turpeenniemi-Hujanen, T., Isola, J., Heikkila, P., Joensuu, H. (2008). Molecular Subtypes of Breast Cancers Detected in Mammography Screening and Outside of Screening. Clin. Cancer Res. 14: 4103-4110 [Abstract] [Full text]
Watts, A. C., Teoh, K., Evans, T., Beggs, I., Robb, J., Porter, D. (2008). MRI surveillance after resection for primary musculoskeletal sarcoma. J Bone Joint Surg Br 90-B: 484-487 [Abstract] [Full text]
Karnon, J., Brennan, A., Akehurst, R. (2007). A Critique and Impact Analysis of Decision Modeling Assumptions. Med Decis Making 27: 491-499 [Abstract]
Mandelblatt, J., Schechter, C. B., Lawrence, W., Yi, B., Cullen, J. (2006). Chapter 8: The SPECTRUM Population Model of the Impact of Screening and Treatment on U.S. Breast Cancer Trends From 1975 to 2000: Principles and Practice of the Model Methods. J Natl Cancer Inst Monogr 2006: 47-55 [Abstract] [Full text]
West, R, DiMarino, M E, Gitchell, J, McNeill, A (2005). Impact of UK policy initiatives on use of medicines to aid smoking cessation. Tobacco Control 14: 166-171 [Abstract] [Full text]
Erbas, B., Amos, A., Fletcher, A., Kavanagh, A. M., Gertig, D. M. (2004). Incidence of Invasive Breast Cancer and Ductal Carcinoma In situ in a Screening Program by Age: Should Older Women Continue Screening?. Cancer Epidemiol. Biomarkers Prev. 13: 1569-1573 [Abstract] [Full text]
Mandelblatt, J., Armetta, C., Yabroff, K. R., Liang, W., Lawrence, W. (2004). Descriptive Review of the Literature on Breast Cancer Outcomes: 1990 Through 2000. J Natl Cancer Inst Monogr 2004: 8-44 [Abstract] [Full text]
Mandelblatt, J., Saha, S., Teutsch, S., Hoerger, T., Siu, A. L., Atkins, D., Klein, J., Helfand, M., for the Cost Work Group of the U.S. Preventive Ser, (2003). The Cost-Effectiveness of Screening Mammography beyond Age 65 Years: A Systematic Review for the U.S. Preventive Services Task Force. ANN INTERN MED 139: 835-842 [Abstract] [Full text]
Postma, M J, Beck, E J, Mandalia, S, Sherr, L, Walters, M D S, Houweling, H, Jager, J C (1999). Universal HIV screening of pregnant women in England: cost effectiveness analysis. BMJ 318: 1656-1660 [Abstract] [Full text]
Gan, T. J., Lubarsky, D. A., Watcha, M. F., White, P. F. (1999). Cost Effectiveness Ratio: An Often Misunderstood Term � Response. Anesth. Analg. 88: 1191-1192 [Full text]
Goodare, H., King, M., Baum, M., Johnson, A., Shekhdar, J., Day, N E, Boer, R., de Koning, H., Threlfall, A., Woodman, C., Street, A., Friedman, E. (1999). NHS breast screening programme. BMJ 318: 397a-397 [Full text]
(1998). Improving Breast Cancer Screening. JWatch Women's Health 1998: 13-13 [Full text]
Werneke, U., McPherson, K. (1998). Extending the benefits of breast cancer screening. BMJ 317: 360-361 [Full text]

Rapid Responses:

Read all Rapid Responses

Cost effectiveness of breast screening: J Mark F Temple
bmj.com, 11 Sep 1998 [Full text]
Modelling is suspect, and results lack confidence intervals: N E Day
bmj.com, 21 Oct 1998 [Full text]