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Título:
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Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model
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Autor/a:
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Comas, Mercè; Arrospide, Arantzazu; Mar, Javier; Sala i Serra, Maria; Vilaprinyo Terré, Ester; Hernández, Cristina; Cots, Francesc; Martínez, Juan; Castells, Xavier
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Notas:
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Objective: To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography
in a population-based breast cancer screening program.
Methods: A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial
mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The
simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered
according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening
programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact
analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A
sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates
were compared.
Results: Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the
long term. The overall cost saving was 1,115,857J (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124J
(95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screenfilm
mammography. The sensitivity analysis showed net savings in the long term.
Conclusions: Switching to digital mammography in a population-based breast cancer screening program saves long-term
budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios
representing the different results obtained in European breast cancer screening programs.
This was supported by grants from the Health Ministry of Spain (Fondo de Investigación Sanitaria PI07/90357). |
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Derechos:
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cc-by, (c) Comas et al., 2014
http://creativecommons.org/licenses/by/3.0/es/
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Tipo de documento:
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article
publishedVersion |
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Editor:
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Public Library of Science
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