Table 1 Main parameters used in the base case and sensitivity analyses
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) | ||
State 1 (clinical diagnostic) | 14% | 13.1–16.6% | Beta (α = 232; β = 1329) | ||
State 2 (clinical diagnostic) | 38.6% | 36.5–40.5% | Beta (α = 915; β = 1455) | ||
State 3 (clinical diagnostic) | 34.7% | 32.4–37.1% | Beta (α = 546; β = 1028) | ||
State 4 (clinical diagnostic) | 10.8% | NA | Complementary | ||
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% | |
Stage 1 | 0.030/y | NA | 16–47% | 53–84% | |
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 | ||
Early BCχ – Adjuvant Endocrine Therapy | 0.762 | 0.62–0.91 | Normal distribution | ||
Early BCχ – Adjuvant Chemotherapy | 0.739 | 0.61–0.87 | Normal distribution | ||
Clinical Stage 3 – Adjuvant Endocrine Therapy | 0.760 | 0.59–0.95 | Normal distribution | ||
Clinical Stage 3 – Adjuvant Chemotherapy | 0.700 | 0.63–0.78 | Normal distribution | ||
Clinical Stage 4 – Advanced disease | 0.680 | 0.57–0.80 | Normal distribution | ||