The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria

• Published in: Value in health 2017-09, Vol.20 (8), p.1048-1057
• Main Authors: Schiller-Fruehwirth, Irmgard, Jahn, Beate, Einzinger, Patrick, Zauner, Günther, Urach, Christoph, Siebert, Uwe
• Format: Article
• Language: English
• Subjects: Adult; Aged; Austria; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - economics; Cancer screening; Clinical outcomes; Cost analysis; Cost control; Cost-Benefit Analysis; cost-effectiveness analysis; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Effectiveness; Female; Health authorities; Health Care Costs; Health care expenditures; Health status; Humans; Individual differences; Long term; Mammography; Mammography - economics; Mammography - methods; Mammography - standards; mass screening; Mass Screening - economics; Mass Screening - methods; Medical screening; microsimulation; Middle Aged; Quality-Adjusted Life Years; Savings; Sensitivity analysis; Simulation; Uncertainty; Willingness to pay; Women
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.04.009

In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria.