The relationship between individual risk and cost-effectiveness in screening interventions

Sampson, Christopher and James, Marilyn and Whynes, David (2013): The relationship between individual risk and cost-effectiveness in screening interventions.

Abstract

Advancements in our understanding of the causes and correlates of disease mean that we are now able to estimate an individual's level of risk. This, and the ever-increasing need for healthcare interventions to be cost-effective, has led to calls for the introduction of risk-based screening. Risk-based screening would involve the use of information about an individual's risk factors to decide whether or not they should be eligible for screening, or the frequency with which they should be invited to attend screening. Evidence is emerging that targeted screening, towards those at higher risk, can increase the cost-effectiveness of a screening programme. The relationship between individual risk and the cost-effectiveness of screening an individual is implicitly recognised in current population screening programmes in the UK. However, the nature of this relationship, and its implications for cost-effectiveness analysis, has not been presented in the academic literature. In this study we propose that an individual's risk of developing a disease has a consistent and quantifiable relationship with the cost-effectiveness of screening them. We suggest a simple modification to standard methods of cost-effectiveness analysis that enables the incorporation of individual risk. Using numerical examples we demonstrate the nature of the relationship between risk and cost-effectiveness and suggest means of optimising a screening intervention. This can be done either by defining a minimum level of risk for eligibility or by defining the optimal recall period for screening. We suggest that methods of decision modelling could enable such an analysis to be carried out, and that information on individual risk could be used to optimise the cost-effectiveness of population screening programmes.

• Item Type: MPRA Paper
• Language: English
• Keywords: risk-based screening; prevention; decision modelling; economic evaluation; personalised medicine
• Subjects: I - Health, Education, and Welfare > I1 - Health > I10 - General

References

Dan YY, Chuah BYS, Koh DCS, Yeoh KG. Screening based on risk for colorectal cancer is the most cost-e�ective approach. Clinical gastroenterology and hepatology. 2012 Mar;10(3):266–71.e1–6.

Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG, Boer R, Wilschut J, Winawer SJ, et al. Individualizing colonoscopy screening by sex and race. Gastrointestinal endoscopy. 2009 Jul;70(1):96–108, 108.e1–24.

Round JA, Jacklin P, Fraser RB, Hughes RG, Mugglestone Ma, Holt RIG. Screening for gestational diabetes mellitus: cost-utility of di�erent screening strategies based on a woman’s individual risk of disease. Diabetologia. 2011 Feb;54(2):256–63.

Aus G, Damber JE, Khatami A, Lilja H, Stranne J, Hugosson J. Individualized screening interval for prostate cancer based on prostate-specific antigen level: results of a prospective, randomized, population-based study. Archives of internal medicine. 2005;165(16):1857.

Bradbury A, Olopade OI. The case for individualized screening recommendations for breast cancer. Journal of Clinical Oncology. 2006 Jul;24(21):3328–30.

Brawley OW. Risk-based mammography screening: an e�ort to maximize the benefits and minimize the harms. Annals of internal medicine. 2012 May;156(9):662–3.

Scanlon PH. 10/66/01 - Development of a cost-e�ectiveness model for optimization of the screening interval in diabetic retinopathy screening. National Institute for Health Research Health Technology Assessment Programme; 2012. May. Available from: http://www.hta.ac.uk/project/2654.

Harding SP. RP-PG-1210-12016 - Introducing personalised risk based intervals in screening for diabetic retinopathy: development, implementation and assessment of safety, cost-e�ectiveness and patient experience. National Institute for Health Research Programme Grants for Applied Research; 2013. Available from: http://www.ccf.nihr.ac.uk/PGfAR/about/Pages/Abstract.aspx?ID=7790.

Aspelund T, Thornorisdottir O, Olafsdottir E, Gudmundsdottir A, Einarsdottir AB, Mehlsen J, et al. Individual risk assessment and information technology to optimise screening frequency for diabetic retinopathy. Diabetologia. 2011 Oct;54(10):2525–32.

Mehlsen J, Erlandsen M, Poulsen PLg, Bek T. Individualized optimization of the screening interval for diabetic retinopathy: a new model. Acta ophthalmologica. 2010 Apr;p. 1–6.

Chalk D, Pitt M, Vaidya B, Stein K. Can the retinal screening interval be safely increased to 2 years for type 2 diabetic patients without retinopathy? Diabetes care. 2012 Aug;35(8):1663–8.

Davies R, Roderick P, Canning C, Brailsford S. The evaluation of screening policies for diabetic retinopathy using simulation. Diabetic Medicine. 2002 Sep;19(9):762–770.

James M, Turner DA, Broadbent DM, Vora J, Harding SP. Cost effectiveness analysis of screening for sight threatening diabetic eye disease. BMJ. 2000 Jun;320(7250):1627–31.

Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996 Nov;348(9040):1472–1477.

Whynes DK. Cost-effectiveness of screening for colorectal cancer: evidence from the Nottingham faecal occult blood trial. Journal of medical screening. 2004 Jan;11(1):11–5.

Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. The Lancet. 2012 Oct;380(9855):1778–1786.