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Table 1 Main parameters used in the base case and sensitivity analyses

From: Is Age-targeted full-field digital mammography screening cost-effective in emerging countries? A micro simulation model

Variables Screening test performance Distribution/comments Reference
  Mean Minimum Maximum   
Mammography coverage 18% 10% 30% Uniform (Ministério_Saúde_Brasil, DATASUS 2011)
Mammography coverage ǁ 70% 55% 85% Uniform (Lilliu et al. 2002)
Sensitivity of SFM (40–49 years) 76% 60% 85% Effectiveness data from large population (Kerlikowske et al. 2011)
Sensitivity of FFDM (40–49 years) 82% 65% 90% Effectiveness data from large population (Kerlikowske et al. 2011)
Sensitivity of SFM (50–59 years) 85% 65% 90% Effectiveness data from large population (Kerlikowske et al. 2011)
Sensitivity of FFDM (50–59 years) 80% 65% 90% Effectiveness data from large population (Kerlikowske et al. 2011)
Sensitivity of SFM (60–69 years) 83% 65% 90% Effectiveness data from large population (Kerlikowske et al. 2011)
Sensitivity of FFDM (60–69 years) 90% 65% 95% Effectiveness data from large population (Kerlikowske et al. 2011)
Treatment complication (yearly) - Chemotherapy 16% 10% 20% Resource utilization database (Hassett et al. 2006)
Treatment complication (yearly) – Endocrine therapy 5% 1% 10% Resource utilization database (Hassett et al. 2006)
Overdiagnosis 5% 0 30% Systematic review estimate (Smith & Duffy 2011)
  Cancer stage distribution   
  Mean CI * 95%   
DCIS (clinical diagnostic) 6.1% 4.9–7.3% Beta (α = 97; β = 1494) (INCA 2009b; Martins et al. 2009)
State 1 (clinical diagnostic) 14% 13.1–16.6% Beta (α = 232; β = 1329) (INCA 2009b; Martins et al. 2009)
State 2 (clinical diagnostic) 38.6% 36.5–40.5% Beta (α = 915; β = 1455) (INCA 2009b; Martins et al. 2009)
State 3 (clinical diagnostic) 34.7% 32.4–37.1% Beta (α = 546; β = 1028) (INCA 2009b; Martins et al. 2009)
State 4 (clinical diagnostic) 10.8% NA Complementary (INCA 2009b; Martins et al. 2009)
CDIS (screening diagnostic) 6.1% NA Dynamic range (Kerlikowske et al. 2011)
State 1 (screening diagnostic) 58%Ξ NA Effectiveness data from large population (Kerlikowske et al. 2011)
State 2 (screening diagnostic) 32.4%Ξ NA Effectiveness data from large population (Kerlikowske et al. 2011)
State 3 (screening diagnostic) 8.3%Ξ NA Effectiveness data from large population (Kerlikowske et al. 2011)
State 4 (screening diagnostic) 1.3%Ξ NA Effectiveness data from large population (Kerlikowske et al. 2011)
  Transition probabilities   
BC Recurrence Mean Range Local Regional/systemic  
CDIS 0.008/y 0.002–0.014/y 50–98% 2–50% (Baxter et al. 2004; Meijnen et al. 2008)
Stage 1 0.030/y NA 16–47% 53–84% (Hirsch et al. 2011a; Hirsch et al. 2011b)
Stage 2 0.087/y NA 19–56% 44–81% (Wapnir et al. 2006)
Stage 3 0.283/y 0,11–0,28/y 19–56% 19–56% (Wapnir et al. 2006)
BC Death Mean Range    
CDIS 0.002/y 0.002–0.003/y    (Ernster et al. 2000)
Stage 1 0.009/y NA    (de Oliveira et al. 2009)
Stage 2 0.031/y NA    (de Oliveira et al. 2009)
Stage 3 0.090/y NA    (de Oliveira et al. 2009)
Stage 4 0.270/y 0.20–0.34    (de Oliveira et al. 2009)
  Relative risk Distribution/comments  
  Mean   
Adjuvant Taxane chemotherapy§ 0.86 Log-Normal (μ = −0.15;σ=0.07) (Peto et al. 2012)
Adjuvant Aromatase inhibitor§¶ 0.82 Log-Normal (μ = −0.20;σ=0.12) (Dowsett et al. 2010)
Adjuvant Trastuzumab therapy §‡ 0.61 Log-Normal (μ = −0.49;σ=0.06) (Perez et al. 2011)
Screening vs. non-screening cancer casesΦ 0,62 Log-Normal (μ= − 0.48;σ=0.12) (Mook et al. 2011)
Advanced disease - Luminal A vs. Luminal B¥ 1.42 Log-Normal (μ = 0.34;σ=0.12) (Kennecke et al. 2010)
Advanced disease - Luminal A vs. HER2 + ¥ 1.90 Log-Normal (μ=0.64;σ=0.11) (Kennecke et al. 2010)
Advanced disease - Luminal A vs. Triple negative¥ 1.62 Log-Normal (μ = 0.48;σ=0.11) (Kennecke et al. 2010)
  Relative odds ratio Distribution/comments  
  Mean   
Diagnostic cancer downstage (FFDM under 50 years) 0.54 Log-Normal (μ= − 0.654;σ=0.307) (Souza et al. 2013)
  Mean Minimum Maximum   
Discount rate 5% 0% 10% Brazilian Health Economic Guidelines (Ministério_Saúde_Brasil 2009)
Costs (Brazilian Real)
  Mean Minimum Maximum   
Medical visit 10 5 25 DATASUS (Ministério_Saúde_Brasil, DATASUS 2011)
FFDM 68 45 90 Estimated (Souza 2012)
SFM 45 30 60 DATASUS (Ministério_Saúde_Brasil, DATASUS 2011)
Biopsy 429 150 700 Gamma (α = 14.93; λ = 0.03) (Souza 2012)
Recall SFM 152 50 250 Aggregate costs (Souza 2012)
Recall FFDM 197 100 300 Aggregate costs (Souza 2012)
Staging early BCΨ 509 250 750 Gamma (α = 3.09 λ=0.01) (Souza 2012)
Staging locally and advanced cancerΔ 592 200 800 Gamma (α = 2.52 λ=0.04) (Souza 2012)
Invasive cancer stage 1 (first year) 6,502 2,500 11,500 Aggregate costs (Souza 2012)
Invasive cancer stage 2 (first year) 15,610 6,500 24,500 Aggregate costs (Souza 2012)
Invasive cancer stage 3 (first year) 18,638 9,500 27,500 Aggregate costs (Souza 2012)
Invasive cancer stage 4 (first year) 12,452 6,500 20,500 Aggregate costs (Souza 2012)
Invasive cancer stage 1 (≥ 2 year) 602 200 1,000 Aggregate costs (Souza 2012)
Invasive cancer stage 2 (≥ 2 year) 677 200 1,200 Aggregate costs (Souza 2012)
Invasive cancer stage 3 (≥ 2 year) 742 200 1,600 Aggregate costs (Souza 2012)
Invasive cancer stage 4 (≥ 2 year) 12,439 4000 20,000 Aggregate costs (Souza 2012)
  Utilities   
  Mean CI * 95%   
Healthy woman 0.800 NA South of Brazil population (Cruz 2010)
Healthy woman – false positive mammography 0.795 NA Estimated (Cruz 2010)
Non metastatic BCχ – follow-up 0.772 0.63–0.90 Normal distribution (Souza 2012; Cruz 2010)
Early BCχ – Adjuvant Endocrine Therapy 0.762 0.62–0.91 Normal distribution (Souza 2012; Cruz 2010)
Early BCχ – Adjuvant Chemotherapy 0.739 0.61–0.87 Normal distribution (Cruz 2012; Cruz 2010)
Clinical Stage 3 – Adjuvant Endocrine Therapy 0.760 0.59–0.95 Normal distribution (Souza 2012; Cruz 2010)
Clinical Stage 3 – Adjuvant Chemotherapy 0.700 0.63–0.78 Normal distribution (Souza 2012; Cruz 2010)
Clinical Stage 4 – Advanced disease 0.680 0.57–0.80 Normal distribution (Souza 2012; Cruz 2010)
  1. ǁ Screening strategies; NA: not applicable; time and screening coverage-dependent (increase in the DCIS rate with the introduction of the screening program); Ξ relative to invasive cancer (excluding DCIS); § Relative risk of BC death in clinical stage 2 and 3 patients; hormone-positive patients; HER2-positive patients; Φ Relative risk of BC death; ¥ Relative risk of BC death in advanced disease (stage 4) according to prognostic subtype; Plausible estimate 50% above SFM reimbursement value; Ψ clinical stages 1 and 2; Δ clinical stages 3 and 4; * confidence interval; Porto Alegre city; Considering the mean of non-metastatic BC utility (0.77) and a false positive as a 2-month period of disutility (0.80–0.77= [(0.03)*(0.16 year)=0.005] →0.80–0.005=0.795; χin situ, stage 1, stage 2, and stage 3 patients.