Analytical approach:
A decision-analytic model was constructed to determine the clinical and economic impact of the alternative screening strategies. The authors did not state the perspective.
Effectiveness data:
The clinical data were from a published randomised controlled trial and the UK NHS Breast Screening Programme (NHSBSP), which provided observational data. The key clinical parameters were the cancers detected, the referral rate, the positive predictive value, and survival.
Monetary benefit and utility valuations:
The utility estimates were from a discussion paper (Kind, et al. 1999, see ‘Other Publications of Related Interest’ below for bibliographic details).
Measure of benefit:
The benefit measure was quality-adjusted life-years (QALYs) and these were discounted at an annual rate of 3.5%. Life-years saved were reported.
Cost data:
The analysis included the direct medical costs of screening, diagnosis, and treatment, for breast cancer. These costs were from NHS Reference Costs. The price year was 2007 and all costs were reported in UK pounds sterling (£). Future costs were discounted at an annual rate of 3.5%.
Analysis of uncertainty:
One-way and probabilistic sensitivity analyses were carried out. The one-way sensitivity analysis varied key model inputs, including the survival time for a fatal cancer, and the QALY loss due to the short-term anxiety from a false-positive result. A Monte Carlo simulation was used to generate cost-effectiveness acceptability curves.