Abstract Objectives To identify the incremental costs and consequences of stratified national breast screening programs (stratified NBSPs) and drivers of relative cost-effectiveness. Methods A decision-analytic model (discrete event simulation) was conceptualized to represent four stratified NBSPs (risk 1, risk 2, masking supplemental screening for women with higher breast density, and masking and risk 1) compared with the current UK NBSP and no screening. The model assumed a lifetime horizon, the health service perspective to identify costs (￡, 2015), and measured consequences in quality-adjusted life-years (QALYs). Multiple data sources were used: systematic reviews of effectiveness and utility, published studies reporting costs, and cohort studies embedded in existing NBSPs. Model parameter uncertainty was assessed using probabilistic sensitivity analysis and one-way sensitivity analysis. Results The base-case analysis, supported by probabilistic sensitivity analysis, suggested that the risk stratified NBSPs (risk 1 and risk-2) were relatively cost-effective when compared with the current UK NBSP, with incremental cost-effectiveness ratios of ￡16,689 per QALY and ￡23,924 per QALY, respectively. Stratified NBSP including masking approaches (supplemental screening for women with higher breast density) was not a cost-effective alternative, with incremental cost-effectiveness ratios of ￡212,947 per QALY (masking) and ￡75,254 per QALY (risk 1 and masking). When compared with no screening, all stratified NBSPs could be considered cost-effective. Key drivers of cost-effectiveness were discount rate, natural history model parameters, mammographic sensitivity, and biopsy rates for recalled cases. A key assumption was that the risk model used in the stratification process was perfectly calibrated to the population. Conclusions This early model-based cost-effectiveness analysis provides indicative evidence for decision makers to understand the key drivers of costs and QALYs for exemplar stratified NBSP.
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机译：摘要 目的 确定分层国家乳腺筛查计划（分层国家乳腺筛查计划）的增量成本和后果以及相对成本效益的驱动因素。方法 采用决策分析模型（离散事件模拟）与现行英国NBSP和无筛查相比，将4个分层NBSP（风险1、风险2、掩蔽[乳腺密度较高女性的补充筛查]和掩蔽和风险1）进行概念化。该模型假设了终生范围、确定成本的卫生服务视角（£，2015），并衡量了质量调整生命年（QALY）的后果。使用了多个数据来源：有效性和效用的系统评价、报告成本的已发表研究以及嵌入现有国家生物多样性战略计划的队列研究。 使用概率敏感性分析和单因素敏感性分析评估模型参数不确定性。结果 基于概率敏感性分析的基准分析表明，与现行的英国国家生物多样性战略计划相比，风险分层的NBSP（风险1和风险-2）具有相对的成本效益，其增量成本效益比分别为16,689英镑/QALY和23,924英镑/QALY。包括掩蔽方法（对乳房密度较高的女性进行补充筛查）在内的分层NBSP不是一种具有成本效益的替代方案，每QALY（掩蔽）的增量成本效益比为212,947英镑，每QALY为75,254英镑（风险1和掩蔽）。与不进行筛查相比，所有分层的NBSP都被认为具有成本效益。成本效益的关键驱动因素是贴现率、自然史模型参数、乳房 X 线摄影敏感性和召回病例的活检率。一个关键的假设是，分层过程中使用的风险模型是根据人群进行完美校准的。结论 这种基于模型的早期成本效益分析为决策者了解示范性分层国家生物多样性战略计划的成本和QALYs的关键驱动因素提供了指示性证据。
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