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Canadian Journal of Public Health

, Volume 105, Issue 5, pp e342–e347 | Cite as

Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: A randomized controlled trial

  • Johanna M. TimmersEmail author
  • Johanna A. Damen
  • Ruud M. Pijnappel
  • André L. Verbeek
  • Gerard J. den Heeten
  • Eddy M. Adang
  • Mireille J. Broeders
Quantitative Research
  • 1 Downloads

Abstract

OBJECTIVE: Increased recall rates in the Dutch breast cancer screening program call for a new assessment strategy aiming to reduce unnecessary costs and anxiety. Diagnostic work-up (usual care) includes multidisciplinary hospital assessment and is similar for all recalled women, regardless of the radiologist’s suspicion of breast cancer. This is similar in many Canadian settings. We developed a novel assessment strategy that offers women with a low suspicion of breast cancer a quick and non-invasive assessment by a screening radiologist (intervention). We compared these two strategies in a cost-effectiveness analysis based on a randomized controlled trial: multicentre randomized controlled trial (MASS trial, Netherlands National Trial Register: NTR1480).

METHODS: Participants were enrolled between August 2010 and December 2012 and were randomly assigned to either the intervention or control group (allocation ratio 2:1). Fourteen assessment centres participated in the study. Questionnaires were used to record quality of life (EuroQol-5D), health care use and costs after recall.

RESULTS: Our study comprised 366 women, of whom 288 were randomly assigned to the intervention group and 88 to the control group. The mean difference in cost was €153/CAD $226 (95% confidence interval €107–199/CAD $158–294, p<0.001). We found no significant differences in quality of life. The bootstrapped incremental cost-effectiveness ratios in the cost-effectiveness plane showed that the intervention was the efficient, cost-saving modality.

CONCLUSION: Our data show the benefits of tailoring diagnostic assessment to the screening radiologist’s suspicion of breast cancer. Scenarios of implementing such a strategy in the Dutch screening or health care system are currently being discussed with various stakeholders.

Keywords

Cost-benefit analysis breast neoplasms early detection of cancer 

Résumé

OBJECTIF : Les taux de rappel accrus dans le programme néerlandais de dépistage du cancer du sein requièrent une nouvelle stratégie d’évaluation des patientes pour réduire les coûts et l’anxiété inutiles. L’investigation diagnostique (les soins habituels) inclut une évaluation multidisciplinaire à l’hôpital; le processus est le même pour toutes les femmes rappelées, peu importe si le radiologiste soupçonne ou non un cancer du sein. Il en va de même dans de nombreux établissements au Canada. Nous avons élaboré une stratégie d’évaluation novatrice qui offre aux femmes pour lesquelles la présomption de cancer du sein est faible une évaluation rapide et non invasive par un médecin radiologiste (intervention). Nous avons comparé ces deux stratégies à la faveur d’une analyse coût-avantage fondée sur un essai comparatif randomisé multicentrique (essai MASS, registre national d’essais des Pays-Bas: NTR1480).

MÉTHODE : Les participantes ont été recrutées entre août 2010 et décembre 2012 et réparties de façon aléatoire entre le groupe d’intervention et un groupe témoin (ratio de répartition 2:1). Quatorze centres d’évaluation ont participé à l’étude. Des questionnaires ont été administrés pour enregistrer la qualité de vie (EuroQol-5D), l’utilisation des soins de santé et les coûts après le rappel.

RÉSULTATS : Notre étude comprenait 366 femmes, dont 288 ont été affectées de façon aléatoire au groupe d’intervention et 88 au groupe témoin. La différence moyenne de coût était de 153 €/226 $CAN (intervalle de confiance de 95%: 107-199 €/158-294 $CAN, p<0,001). Nous n’avons trouvé aucune différence significative dans la qualité de vie. Les ratios coût-efficacité incrémentiels (selon la méthode bootstrap) indiquent que l’intervention est la méthode la plus efficiente et économique.

CONCLUSION : Nos données montrent les avantages d’adapter l’évaluation diagnostique selon que le médecin radiologiste qui effectue le dépistage soupçonne ou non un cancer du sein. On discute actuellement avec divers acteurs du milieu de scénarios de mise en œuvre d’une telle stratégie dans le système néerlandais de dépistage ou de soins de santé.

Motsclés

analyse coût-bénéfice tumeurs du sein dépistage précoce du cancer 

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Copyright information

© The Canadian Public Health Association 2014

Authors and Affiliations

  • Johanna M. Timmers
    • 1
    Email author
  • Johanna A. Damen
    • 1
    • 2
  • Ruud M. Pijnappel
    • 1
    • 3
  • André L. Verbeek
    • 1
    • 2
  • Gerard J. den Heeten
    • 1
    • 4
  • Eddy M. Adang
    • 2
  • Mireille J. Broeders
    • 1
    • 2
  1. 1.Dutch Reference Centre for ScreeningNijmegenthe Netherlands
  2. 2.Department for Health EvidenceRadboud University Medical CenterRadboudthe Netherlands
  3. 3.Department of RadiologyUniversity Medical CentreUtrechtthe Netherlands
  4. 4.Department of Radiology, Academic Medical CentreUniversity of AmsterdamAmsterdamthe Netherlands

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