The cost-effectiveness of risk stratified breast cancer screening in the UK

Background: There has been growing interest in the UK and internationally of risk stratified breast screening whereby individualised risk assessment may inform screening frequency, starting age, screening instrument used, or even decisions not to screen. We evaluate the cost-effectiveness of eight proposals for risk-stratified screening regimens compared to the current UK screening programme and compared to no national screening.

Method: A person-level discrete-event simulation was developed to track health-related quality of life, cancer survival and NHS costs over the lifetime of the female population of the UK.

Results: Compared with the current screening programme, all risk-stratified regimens generated additional costs and QALYs, and had a larger net monetary benefit. No screening amongst the lowest risk group, and triannual, biennial and annual screening amongst the three higher risk groups was the optimal screening strategy from those evaluated.

Conclusion: Risk stratified breast cancer screening has the potential to be beneficial for women at the population level, but cost-effectiveness will depend on the particular risk-based strategy. Not offering breast cancer screening to women at the lowest risk of breast cancer is a more cost-effective form of risk-stratified screening than offering them the current UK screening programme.

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