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

  • Quantitative Research
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Canadian Journal of Public Health Aims and scope Submit manuscript

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.

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.

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Authors and Affiliations

  1. Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, the Netherlands

    Johanna M. Timmers PhD, Johanna A. Damen MSc, Ruud M. Pijnappel MD, PhD, André L. Verbeek MD, PhD, Gerard J. den Heeten MD, PhD & Mireille J. Broeders PhD

  2. Department for Health Evidence, Radboud University Medical Center, Radboud, the Netherlands

    Johanna A. Damen MSc, André L. Verbeek MD, PhD, Eddy M. Adang PhD & Mireille J. Broeders PhD

  3. Department of Radiology, University Medical Centre, Utrecht, the Netherlands

    Ruud M. Pijnappel MD, PhD

  4. Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands

    Gerard J. den Heeten MD, PhD

Authors
  1. Johanna M. Timmers PhD
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  2. Johanna A. Damen MSc
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  3. Ruud M. Pijnappel MD, PhD
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  4. André L. Verbeek MD, PhD
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  5. Gerard J. den Heeten MD, PhD
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  6. Eddy M. Adang PhD
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  7. Mireille J. Broeders PhD
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Corresponding author

Correspondence to Johanna M. Timmers PhD.

Additional information

Acknowledgements: This study was supported by a grant from the Dutch Organization for Health Research and Development (ZonMw). ZonMw had no influence on the study design, collection of data, data analysis, interpretation, writing of the manuscript or the decision to submit the manuscript for publication. We thank all participating women for taking the time to complete our questionnaires during a most distressing period. We also acknowledge all screening radiologists, research assistants, assessment centres and hospitals for their valuable contribution to this study.

Conflict of Interest: None to declare.

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Timmers, J.M., Damen, J.A., Pijnappel, R.M. et al. Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: A randomized controlled trial. Can J Public Health 105, e342–e347 (2014). https://doi.org/10.17269/cjph.105.4463

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  • DOI: https://doi.org/10.17269/cjph.105.4463

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