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Budget Impact Analysis of Cancer Screening: A Methodological Review

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Abstract

Background

Budget impact analyses (BIAs) describe changes in intervention- and disease-related costs of new technologies. Evidence on the quality of BIAs for cancer screening is lacking.

Objectives

We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs.

Data sources

Systematic searches were conducted in MEDLINE, EMBASE, EconLit, CRD (Centre for Reviews and Dissemination, University of York), and CEA registry of the Tufts Medical Center.

Study eligibility criteria

Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010–2018.

Synthesis methods

Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force.

Results

Nineteen studies were identified evaluating screening for breast (5), colorectal (6), cervical (3), lung (1), prostate (3), and skin (1) cancers. Model designs included decision-analytic models (13) and simple cost calculators (6). From all studies, only 53% reported costs for a minimum of 3 years, 58% compared to a mix of screening options, 42% reported model validation, and 37% reported uncertainty analysis for participation rates. The quality of studies appeared to be independent of cancer site.

Limitations

“Gray” literature was not searched, misinterpretation is possible due to limited information in publications, and focus was on international methodological guidelines rather than regional guidelines.

Conclusions

Our review highlights considerable variability in the extent to which BIAs evaluating cancer-screening programs followed recommended guidelines. The annual budget impact at least over the next 3–5 years should be estimated. Validation and uncertainty analysis should always be conducted. Continued dissemination efforts of existing best-practice guidelines are necessary to ensure high-quality analyses.

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Acknowledgements

This project has been part of the DEXHELPP (Decision Support for Health Policy and Planning: Methods, Models and Technologies based on Existing Health Care Data) project in the frame of COMET-Competence Centers for Excellent Technologies supported by BMVIT, BMWFW and the state Vienna, by UMIT (University for Health Sciences, Medical Informatics and Technology), and by Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission. We thank Kelley J. P. Lindberg for proofreading and language editing.

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Authors and Affiliations

  1. Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria

    Beate Jahn, Jovan Todorovic, Marvin Bundo, Gaby Sroczynski, Annette Conrads-Frank, Ursula Rochau & Uwe Siebert

  2. Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria

    Gottfried Endel, Ingrid Wilbacher & Nikoletta Malbaski

  3. DWH Simulation Services, DEXHELPP, Neustiftgasse 57-59, 1070, Vienna, Austria

    Niki Popper

  4. TU Wien, Information and Software Engineering Group (ifs - E194-01), Favoritenstraße 9-11/194-01, 1040, Vienna, Austria

    Niki Popper

  5. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA

    Jagpreet Chhatwal & Uwe Siebert

  6. Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva, Israel

    Dan Greenberg

  7. RTI Health Solutions, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA

    Josephine Mauskopf

  8. Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Karl-Kapferer-Straße 5, 6020, Innsbruck, Austria

    Uwe Siebert

  9. Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA

    Uwe Siebert

Authors
  1. Beate Jahn
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  2. Jovan Todorovic
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  3. Marvin Bundo
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  4. Gaby Sroczynski
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  5. Annette Conrads-Frank
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  6. Ursula Rochau
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  7. Gottfried Endel
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  8. Ingrid Wilbacher
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  9. Nikoletta Malbaski
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  10. Niki Popper
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  11. Jagpreet Chhatwal
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  12. Dan Greenberg
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  13. Josephine Mauskopf
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  14. Uwe Siebert
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Contributions

BJ, JT, MB, and US made substantial contributions to conception and design, acquisition of information, analysis and interpretation of results. BJ, JT, MB, GS, ACF, UR, GE, IW, NM, NP, JC, DG, JM, and US were involved in drafting the manuscript and revising it critically for important intellectual content. BJ, JT, MB, GS, ACF, UR, GE, IW, NM, NP, JC, DG, JM, and US agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Uwe Siebert.

Ethics declarations

The study was registered at the ethics committee of UMIT (University for Health Sciences, Medical Computer Science and Technology), Hall i.T. Austria (Registration 2162). Ethical standards were followed.

Availability of data and material

All data and material are available in published, mentioned, and referenced studies.

Conflict of interest

The authors (Jahn B, Todorovic J, Bundo M, Sroczynski G, Conrads-Frank A, Rochau U, Endel G, Wilbacher I, Malbaski N, Popper N, Chhatwal J, Greenberg D, Mauskopf J, Siebert U) declare that they have no competing interests.

Funding

This project was supported in part by DEXHELPP (Decision Support for Health Policy and Planning: Methods, Models and Technologies based on Existing Health Care Data, Grant no. 843550). DEXHELPP is in the frame of COMET-Competence Centers for Excellent Technologies. DEXHELPP is supported by BMVIT, BMWFW and the state Vienna. The COMET program is transacted by the FFG. In parts, this work has also been financially supported through Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission. The funding body did not have any influence on the design of the study and collection, analysis, and interpretation of data and in manuscript writing.

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Jahn, B., Todorovic, J., Bundo, M. et al. Budget Impact Analysis of Cancer Screening: A Methodological Review. Appl Health Econ Health Policy 17, 493–511 (2019). https://doi.org/10.1007/s40258-019-00475-6

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