Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis

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2016Author
Arrospide, Arantzazu
Ravesteyn, Nicolien T. van
Comas, Mercè
Soto-Gordoa, Myriam
Sarriugarte, Garbiñe
Mar, Javier
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Arrospide, Arantzazu;
Rué i Monné, Montserrat;
Ravesteyn, Nicolien T. van;
Comas, Mercè;
Soto-Gordoa, Myriam;
Sarriugarte, Garbiñe;
Mar, Javier;
.
(2016)
.
Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis.
BMC Cancer, 2016, vol. 16, núm. 344.
https://doi.org/10.1186/s12885-016-2386-y.
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Background: Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC
deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate
the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness
and budget impact from 1996 to 2011.
Methods: A discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We
estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted
life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the
actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was
calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both
population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess
the impact of parameters uncertainty.
Results: The actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs
over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million
euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY.
All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower
than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health
Service by 5.2 million euros from year 2000 onwards.
Conclusions: The BC screening programme in the Basque Country proved to be cost-effective during the
evaluated period and determined an affordable budget impact. These results confirm the epidemiological
benefits related to the centralised screening system and support the continuation of the programme.
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BMC Cancer, 2016, vol. 16, núm. 344European research projects
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