Valuing the health states associated with breast cancer screening programmes: a systematic review of economic measures

Hannah L. Bromley, Dennis Petrie, G. Bruce Mann, Carolyn Nickson, Daniel Rea, Tracy E. Roberts

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Policy decisions regarding breast cancer screening and treatment programmes may be misplaced unless the decision process includes the appropriate utilities and disutilities of mammography screening and its sequelae. The objectives of this study were to critically review how economic evaluations have valued the health states associated with breast cancer screening, and appraise the primary evidence informing health state utility values (cardinal measures of quality of life). A systematic review was conducted up to September 2018 of studies that elicited or used utilities relevant to mammography screening. The methods used to elicit utilities and the quality of the reported values were tabulated and analysed narratively. 40 economic evaluations of breast cancer screening programmes and 10 primary studies measuring utilities for health states associated with mammography were reviewed in full. The economic evaluations made different assumptions about the measures used, duration applied and the sequalae included in each health state. 22 evaluations referenced utilities based on assumptions or used measures that were not methodologically appropriate. There was significant heterogeneity in the utilities generated by the 10 primary studies, including the methods and population used to derive them. No study asked women to explicitly consider the risk of overdiagnosis when valuing the health states described. Utilities informing breast screening policy are restricted in their ability to reflect the full benefits and harms. Evaluating the true cost-effectiveness of breast cancer screening will remain problematic, unless the methodological challenges associated with valuing the disutilities of screening are adequately addressed.

Original languageEnglish
Pages (from-to)142-154
Number of pages13
JournalSocial Science and Medicine
Volume228
DOIs
Publication statusPublished - May 2019

Keywords

  • Breast cancer
  • Health state utility value
  • Mammography
  • QALY
  • Quality of life
  • Screening

Cite this

Bromley, Hannah L. ; Petrie, Dennis ; Mann, G. Bruce ; Nickson, Carolyn ; Rea, Daniel ; Roberts, Tracy E. / Valuing the health states associated with breast cancer screening programmes : a systematic review of economic measures. In: Social Science and Medicine. 2019 ; Vol. 228. pp. 142-154.
@article{5cebc0c1d28140c7ad0427db959f8009,
title = "Valuing the health states associated with breast cancer screening programmes: a systematic review of economic measures",
abstract = "Policy decisions regarding breast cancer screening and treatment programmes may be misplaced unless the decision process includes the appropriate utilities and disutilities of mammography screening and its sequelae. The objectives of this study were to critically review how economic evaluations have valued the health states associated with breast cancer screening, and appraise the primary evidence informing health state utility values (cardinal measures of quality of life). A systematic review was conducted up to September 2018 of studies that elicited or used utilities relevant to mammography screening. The methods used to elicit utilities and the quality of the reported values were tabulated and analysed narratively. 40 economic evaluations of breast cancer screening programmes and 10 primary studies measuring utilities for health states associated with mammography were reviewed in full. The economic evaluations made different assumptions about the measures used, duration applied and the sequalae included in each health state. 22 evaluations referenced utilities based on assumptions or used measures that were not methodologically appropriate. There was significant heterogeneity in the utilities generated by the 10 primary studies, including the methods and population used to derive them. No study asked women to explicitly consider the risk of overdiagnosis when valuing the health states described. Utilities informing breast screening policy are restricted in their ability to reflect the full benefits and harms. Evaluating the true cost-effectiveness of breast cancer screening will remain problematic, unless the methodological challenges associated with valuing the disutilities of screening are adequately addressed.",
keywords = "Breast cancer, Health state utility value, Mammography, QALY, Quality of life, Screening",
author = "Bromley, {Hannah L.} and Dennis Petrie and Mann, {G. Bruce} and Carolyn Nickson and Daniel Rea and Roberts, {Tracy E.}",
year = "2019",
month = "5",
doi = "10.1016/j.socscimed.2019.03.028",
language = "English",
volume = "228",
pages = "142--154",
journal = "Social Science and Medicine",
issn = "0277-9536",
publisher = "Pergamon",

}

Valuing the health states associated with breast cancer screening programmes : a systematic review of economic measures. / Bromley, Hannah L.; Petrie, Dennis; Mann, G. Bruce; Nickson, Carolyn; Rea, Daniel; Roberts, Tracy E.

In: Social Science and Medicine, Vol. 228, 05.2019, p. 142-154.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Valuing the health states associated with breast cancer screening programmes

T2 - a systematic review of economic measures

AU - Bromley, Hannah L.

AU - Petrie, Dennis

AU - Mann, G. Bruce

AU - Nickson, Carolyn

AU - Rea, Daniel

AU - Roberts, Tracy E.

PY - 2019/5

Y1 - 2019/5

N2 - Policy decisions regarding breast cancer screening and treatment programmes may be misplaced unless the decision process includes the appropriate utilities and disutilities of mammography screening and its sequelae. The objectives of this study were to critically review how economic evaluations have valued the health states associated with breast cancer screening, and appraise the primary evidence informing health state utility values (cardinal measures of quality of life). A systematic review was conducted up to September 2018 of studies that elicited or used utilities relevant to mammography screening. The methods used to elicit utilities and the quality of the reported values were tabulated and analysed narratively. 40 economic evaluations of breast cancer screening programmes and 10 primary studies measuring utilities for health states associated with mammography were reviewed in full. The economic evaluations made different assumptions about the measures used, duration applied and the sequalae included in each health state. 22 evaluations referenced utilities based on assumptions or used measures that were not methodologically appropriate. There was significant heterogeneity in the utilities generated by the 10 primary studies, including the methods and population used to derive them. No study asked women to explicitly consider the risk of overdiagnosis when valuing the health states described. Utilities informing breast screening policy are restricted in their ability to reflect the full benefits and harms. Evaluating the true cost-effectiveness of breast cancer screening will remain problematic, unless the methodological challenges associated with valuing the disutilities of screening are adequately addressed.

AB - Policy decisions regarding breast cancer screening and treatment programmes may be misplaced unless the decision process includes the appropriate utilities and disutilities of mammography screening and its sequelae. The objectives of this study were to critically review how economic evaluations have valued the health states associated with breast cancer screening, and appraise the primary evidence informing health state utility values (cardinal measures of quality of life). A systematic review was conducted up to September 2018 of studies that elicited or used utilities relevant to mammography screening. The methods used to elicit utilities and the quality of the reported values were tabulated and analysed narratively. 40 economic evaluations of breast cancer screening programmes and 10 primary studies measuring utilities for health states associated with mammography were reviewed in full. The economic evaluations made different assumptions about the measures used, duration applied and the sequalae included in each health state. 22 evaluations referenced utilities based on assumptions or used measures that were not methodologically appropriate. There was significant heterogeneity in the utilities generated by the 10 primary studies, including the methods and population used to derive them. No study asked women to explicitly consider the risk of overdiagnosis when valuing the health states described. Utilities informing breast screening policy are restricted in their ability to reflect the full benefits and harms. Evaluating the true cost-effectiveness of breast cancer screening will remain problematic, unless the methodological challenges associated with valuing the disutilities of screening are adequately addressed.

KW - Breast cancer

KW - Health state utility value

KW - Mammography

KW - QALY

KW - Quality of life

KW - Screening

UR - http://www.scopus.com/inward/record.url?scp=85063341383&partnerID=8YFLogxK

U2 - 10.1016/j.socscimed.2019.03.028

DO - 10.1016/j.socscimed.2019.03.028

M3 - Review Article

VL - 228

SP - 142

EP - 154

JO - Social Science and Medicine

JF - Social Science and Medicine

SN - 0277-9536

ER -