Evaluation of a Stratified National Breast Screening Program in the United Kingdom: An Early Model-Based Cost-Effectiveness Analysis

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Category: Breast Screening Programs

Tags: Model 13

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Disease Area (Primary)

Breast Screening Programs

Disease Area (Secondary)

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First Developed

05/16/2025

Last Developed

06/30/2025

Software Used

R (e.g., heemod, BCEA, dampack, hesim)

Model Sponsor

Government agency

Intervention

stratified_screening

Model Validation Score

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Results

The base-case analysis, supported by probabilistic sensitivity analysis, suggested that the risk stratified NBSPs (risk 1 and risk-2) were relatively cost-effective when compared with the current UK NBSP, with incremental cost-effectiveness ratios of £16,689 per QALY and £23,924 per QALY, respectively. Stratified NBSP including masking approaches (supplemental screening for women with higher breast density) was not a cost-effective alternative, with incremental cost-effectiveness ratios of £212,947 per QALY (masking) and £75,254 per QALY (risk 1 and masking). When compared with no screening, all stratified NBSPs could be considered cost-effective.

Conclusion

This early model-based CEA presents indicative results that suggest that a risk stratified NBSP is potentially a cost-effective use of health care resources when compared with the current UK NBSP. The proposed model structure will be a key resource as more data become available to support the introduction of stratified NBSP such as the sensitivity and effectiveness of the new screening modalities, the effect of risk communication strategies on NBSP uptake, and the cost of newer treatments for breast cancer.

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Model Review

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Summary

Validation Score

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Internal Comments

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Full review

01 Model Built Reflective	yes
02 Model Subgroups	yes
03 Model Assesses all comparators	yes
04 Model Incorporates costs	yes
05 Model assesses all outcomes	yes

06 Model structure validated by experts	yes
07 Model aligns with or justifies deviation from previous models	yes

08 Time in health states	yes
09 Consistency with time in states	yes
10 Clinical events extractable	yes
11 Consistency with number of clinical events	yes
12 Impact of adverse events	yes
13 Consistency with adverse events	yes
14 Life-years reported	yes
15 Impact on mortality	yes
16a Reasons for mortality differences	yes
16b Reasons for mortality differences	yes
16c Reasons for mortality differences	yes
16d Reasons for mortality differences	yes
17 Main driver of incremental life-years	yes
18 Consistency with mortality rates	yes
19 No technology-specific utilities used	yes
20 Main driver of cost-effectiveness	yes
21 Extrapolation methods identified	yes
22 Adjustable time horizon	yes
23 Double counting avoided	yes
24 Surrogate vs final outcomes alignment	yes
25 Flexibility for treatment effect waning	yes

26 Access to deterministic and Monte Carlo results	yes
27 Clear trace from inputs to outcomes	yes
28 Macros used only for simulation/navigation (Excel)	yes

29 QALY equivalence across technologies	yes
30 Extreme effectiveness impact on QALY	yes
31 Slight effectiveness impact on QALY	yes
32 Increased mortality lowers QALYs	yes
33 Reduced mortality increases QALYs	yes
34 Increased baseline risk lowers QALYs	yes
35 Reduced baseline risk increases QALYs	yes
36 Zero mortality leads to equal life-years	yes
37 Cost change affects only total costs	yes
38 Utilities = 1 makes QALYs equal life-years	yes
39 No discounting increases QALYs/costs	yes
40 Higher discounting decreases QALYs/costs	yes
41 Shorter time horizon lowers QALYs/costs	yes
42 Inputs switchable across alternatives	yes
43 Cost-QALY correlation across simulations	yes
44 Strong cost correlation from Monte Carlo	yes
45 Strong QALY correlation from Monte Carlo	yes
46 Deterministic ≈ Probabilistic results	yes

47 Backward trace from results to inputs	yes
48 Backward trace from results to inputs	yes

49 No use of non-transparent Excel functions	yes
50 No hidden sheets, rows, or columns	yes
51 No custom formulas inside VBA macros	yes
52 Parameters persist after macros	yes
53 Transparent input structure in single worksheet	yes
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