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01-02-2018 | Epidemiology

Comparative effectiveness of incorporating a hypothetical DCIS prognostic marker into breast cancer screening

Authors: Amy Trentham-Dietz, Mehmet Ali Ergun, Oguzhan Alagoz, Natasha K. Stout, Ronald E. Gangnon, John M. Hampton, Kim Dittus, Ted A. James, Pamela M. Vacek, Sally D. Herschorn, Elizabeth S. Burnside, Anna N. A. Tosteson, Donald L. Weaver, Brian L. Sprague

Published in: Breast Cancer Research and Treatment | Issue 1/2018

Abstract

Purpose

Due to limitations in the ability to identify non-progressive disease, ductal carcinoma in situ (DCIS) is usually managed similarly to localized invasive breast cancer. We used simulation modeling to evaluate the potential impact of a hypothetical test that identifies non-progressive DCIS.

Methods

A discrete-event model simulated a cohort of U.S. women undergoing digital screening mammography. All women diagnosed with DCIS underwent the hypothetical DCIS prognostic test. Women with test results indicating progressive DCIS received standard breast cancer treatment and a decrement to quality of life corresponding to the treatment. If the DCIS test indicated non-progressive DCIS, no treatment was received and women continued routine annual surveillance mammography. A range of test performance characteristics and prevalence of non-progressive disease were simulated. Analysis compared discounted quality-adjusted life years (QALYs) and costs for test scenarios to base-case scenarios without the test.

Results

Compared to the base case, a perfect prognostic test resulted in a 40% decrease in treatment costs, from $13,321 to $8005 USD per DCIS case. A perfect test produced 0.04 additional QALYs (16 days) for women diagnosed with DCIS, added to the base case of 5.88 QALYs per DCIS case. The results were sensitive to the performance characteristics of the prognostic test, the proportion of DCIS cases that were non-progressive in the model, and the frequency of mammography screening in the population.

Conclusion

A prognostic test that identifies non-progressive DCIS would substantially reduce treatment costs but result in only modest improvements in quality of life when averaged over all DCIS cases.

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Title: Comparative effectiveness of incorporating a hypothetical DCIS prognostic marker into breast cancer screening
Authors: Amy Trentham-Dietz
Mehmet Ali Ergun
Oguzhan Alagoz
Natasha K. Stout
Ronald E. Gangnon
John M. Hampton
Kim Dittus
Ted A. James
Pamela M. Vacek
Sally D. Herschorn
Elizabeth S. Burnside
Anna N. A. Tosteson
Donald L. Weaver
Brian L. Sprague
Publication date: 01-02-2018
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 1/2018
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4582-0

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