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. 2023 Nov;129(11):1801-1809.
doi: 10.1038/s41416-023-02461-1. Epub 2023 Oct 17.

The cost-effectiveness of risk-stratified breast cancer screening in the UK

Harry Hill  1 , Ben Kearns  2   3 , Nora Pashayan  4 , Cristina Roadevin  5 , Peter Sasieni  6   7 , Judith Offman  6   7 , Stephen Duffy  7
Affiliations

The cost-effectiveness of risk-stratified breast cancer screening in the UK

Harry Hill et al. Br J Cancer. 2023 Nov.

Abstract

Background: There has been growing interest in the UK and internationally of risk-stratified breast screening whereby individualised risk assessment may inform screening frequency, starting age, screening instrument used, or even decisions not to screen. This study evaluates the cost-effectiveness of eight proposals for risk-stratified screening regimens compared to both the current UK screening programme and no national screening.

Methods: A person-level microsimulation model was developed to estimate health-related quality of life, cancer survival and NHS costs over the lifetime of the female population eligible for screening in the UK.

Results: Compared with both the current screening programme and no screening, risk-stratified regimens generated additional costs and QALYs, and had a larger net health benefit. The likelihood of the current screening programme being the optimal scenario was less than 1%. No screening amongst the lowest risk group, and triannual, biennial and annual screening amongst the three higher risk groups was the optimal screening strategy from those evaluated.

Conclusions: We found that risk-stratified breast cancer screening has the potential to be beneficial for women at the population level, but the net health benefit will depend on the particular risk-based strategy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Natural history of cancer.
Structure of events in the model.
Fig. 2
Fig. 2. Natural history of cancer.
Illustration of the progression of cancer in the model.
See this image and copyright information in PMC

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