Cost-Effectiveness of Organized Screening for Breast Cancer in Finland

Abstract

The latest expansion of the Finnish Breast Cancer Screening Program (FBCSP) from covering women aged 50–59 to invite all women aged 50–69 to biennial screening, has not retrospectively been evaluated as to its cost-effectiveness. The debate on further expanding the FBCSP to younger and older age groups divides decision makers and the medical community alike. This study seeks to shed new light on the cost-effectiveness of the current FBCSP screening strategy with regard to age groups covered by it, as well as to inform the controversy surrounding the optimal screening strategy. A decision-analytic model was developed to perform a Cost-Utility Analysis (CUA), assessing the cost-effectiveness of the current FBCSP screening strategy compared to no screening, as well as that of expanding the program to all women aged 40–74 compared to the current FBCSP strategy, expressed in costs per incremental Quality-Adjusted Life Year (QALY). Applying a stage-shift approach, screening strategies are superimposed on a natural history model reflecting a scenario without screening, allowing for interruption of the natural progression of breast cancer through early detection of malignant tumors. Compared to no screening, the incremental cost-effectiveness ratio (ICER) of the current FBCSP strategy was estimated to €18 584 per QALY gained. The cost-effectiveness of the more extensive screening strategy was estimated to €21 580 per QALY gained, compared to the current FBCSP strategy. While mammography screening is likely to have health benefits to mortality and morbidity associated with breast cancer, the true effectiveness and cost-effectiveness of breast cancer screening through early detection is unclear. Further research to resolve uncertainty around the accuracy of mammography screening and to inform the controversy surrounding overdiagnosis is called for, in support of decision making regarding the optimal strategy for the FBCSP.