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Implementing a Risk-Stratified National Breast Screening Programme in the United Kingdom: a model-based
Stuart J Wright1, Joe Hilton1, Gabriel Rogers1
1University of Manchester Manchester United Kingdom.
Summary
Risk-stratified breast screening offers tailored screening intervals based on individual risk. Implementing this approach in the UK National Breast Screening Programme could improve cancer detection cost-effectively.
Area of Science:
- Health economics
- Oncology
- Public health
Background:
- Risk-stratified breast screening is proposed to enhance benefits within the UK National Health Service Breast Screening Programme.
- Current screening strategies require evaluation for cost-effectiveness.
Purpose of the Study:
- To explore the cost-effectiveness of various risk-stratified breast screening strategies.
- To compare these strategies against the current UK National Health Service Breast Screening Programme and no screening.
Main Methods:
- A validated discrete event simulation model (MANC-RISK-SCREEN) was adapted to assess cost-effectiveness.
- Evaluated three risk-stratified approaches against current UK National Health Service Breast Screening Programme and no screening over a lifetime horizon.
- Accounted for risk misclassification and quantified uncertainty using sensitivity analyses.
Main Results:
- Two-yearly screening was most cost-effective at £20,000 per QALY.
- Risk-stratified screening (annual for high-risk, bi-annual for moderate-risk) showed improved ranking when risk misclassification was considered.
- Risk-stratified approaches demonstrated potential for improved cancer detection.
Conclusions:
- Risk-stratified breast screening is a cost-effective alternative if two-yearly screening is not feasible due to resource constraints.
- Implementation can enhance cancer detection with reasonable resource use and cost in the UK National Health Service Breast Screening Programme.
