Personalized Mammography Screening and Screening Adherence: A Simulation and Economic Evaluation

TY - JOUR

T1 - Personalized Mammography Screening and Screening Adherence

T2 - A Simulation and Economic Evaluation

AU - Arnold, Matthias

AU - Quante, Anne S.

N1 - © 2018, International Society for Pharmacoeconomics andOutcomes Research (ISPOR). Published by Elsevier Inc. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

PY - 2018/7

Y1 - 2018/7

N2 - Objective: Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies. Methods: Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies. Results: First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000. Conclusions: Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.

AB - Objective: Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies. Methods: Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies. Results: First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000. Conclusions: Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.

KW - Adherence

KW - Breast cancer screening

KW - Decision analysis

KW - Economic evaluation

KW - Mammography

KW - Markov model

KW - Personalized medicine

UR - http://www.scopus.com/inward/record.url?scp=85042214878&partnerID=8YFLogxK

U2 - 10.1016/j.jval.2017.12.022

DO - 10.1016/j.jval.2017.12.022

M3 - Article

AN - SCOPUS:85042214878

SN - 1098-3015

VL - 21

SP - 799

EP - 808

JO - Value in Health

JF - Value in Health

IS - 7

ER -