Cost-Effectiveness Analysis of Digital Breast Tomosynthesis Added to Synthetic Mammography in Breast Cancer Screening in Brazil.

IF 2 Q2 ECONOMICS

PharmacoEconomics Open Pub Date : 2024-05-01 Epub Date: 2024-01-18 DOI:10.1007/s41669-023-00470-7

Henrique Lima Couto, Ludmila Peres Gargano, Vilmar Marques de Oliveira, Bertha Andrade Coelho, Eduardo Carvalho Pessoa, Augusto Tufi Hassan, Agnaldo Lopes Silva, Linei Augusta Brolini Delle Urban, Luciano Chala Fernandes, Nisha Sharma, Ritse Mann, Stuart A McIntosh, Fernando Zanghelini

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引用次数: 0

Abstract

Background: Literature meta-analysis results show that digital breast tomosynthesis (DBT) combined with synthesized two-dimensional (s2D) mammograms can reduce recalls and improve breast cancer detection. Uncertainty regarding the screening of patients with breast cancer presents a health economic challenge, both in terms of healthcare resource use and quality of life impact on patients.

Objective: This study aims to estimate the cost effectiveness of DBT + s2D versus digital mammography (DM) used in a biennial breast cancer screening setting of women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts in the Brazilian supplementary health system.

Methods: A cost-effectiveness analysis was performed on the basis of clinical data obtained from a systematic review with meta-analysis performed to evaluate the analytical validity and clinical utility of DBT + s2D compared with DM. The search was conducted in the PubMed, Cochrane Library and Embase databases, with the main descriptors of the technology, a comparator, and the clinical condition in question, on 9 June 2022. The hybrid economic model (decision tree plus Markov model) simulated costs and outcomes over a lifetime for women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts. We analyzed incremental cost-effectiveness ratio (ICER) to measure the incremental cost difference per quality-adjusted life year (QALY) of adding DBT + s2D to breast cancer screening.

Results: DBT + s2D incurred a cost saving of € 954.02 per patient, in the time horizon of 30 years, compared with DM, and gained 5.1989 QALYs, which would be considered a dominant intervention. These results were confirmed in sensitivity analyses.

Conclusion: Switching from DM to biennial DBT + s2D was cost effective. Furthermore, reductions in false-positive recall rates should also be considered in decision making.

查看原文本刊更多论文

巴西乳腺癌筛查中数字乳腺断层成像与合成乳腺 X 线照相术的成本效益分析。

背景：文献荟萃分析结果表明，数字乳腺断层扫描（DBT）与合成二维（s2D）乳房X光检查相结合可减少召回率并提高乳腺癌的检测率。乳腺癌患者筛查的不确定性给医疗经济带来了挑战，无论是在医疗资源使用方面还是在对患者生活质量的影响方面都是如此：本研究旨在估算 DBT + s2D 与数字乳腺 X 线照相术（DM）在巴西辅助医疗系统中两年一次的乳腺癌筛查中的成本效益：根据系统综述获得的临床数据进行了成本效益分析，并进行了荟萃分析，以评估 DBT + s2D 与 DM 相比的分析有效性和临床实用性。该研究于 2022 年 6 月 9 日在 PubMed、Cochrane Library 和 Embase 数据库中进行了检索，主要描述了相关技术、参照物和临床状况。混合经济模型（决策树加马尔科夫模型）模拟了 40-69 岁女性一生中患散在纤维腺体乳腺密度区和异质性致密乳腺的成本和结果。我们分析了增量成本效益比（ICER），以衡量在乳腺癌筛查基础上增加 DBT + s2D 的每质量调整生命年（QALY）的增量成本差异：与 DM 相比，DBT + s2D 在 30 年的时间跨度内为每位患者节省了 954.02 欧元的成本，并获得了 5.1989 QALY，这被认为是一种优势干预措施。这些结果在敏感性分析中得到了证实：结论：将 DM 改为两年一次的 DBT + s2D 具有成本效益。此外，在决策时还应考虑降低假阳性召回率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PharmacoEconomics Open Multiple-

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

8 weeks

期刊介绍： PharmacoEconomics - Open focuses on applied research on the economic implications and health outcomes associated with drugs, devices and other healthcare interventions. The journal includes, but is not limited to, the following research areas:Economic analysis of healthcare interventionsHealth outcomes researchCost-of-illness studiesQuality-of-life studiesAdditional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in PharmacoEconomics -Open may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.