Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness

American Society of Breast Disease, Frisco, TX 75034, United States.
Breast (Edinburgh, Scotland) (Impact Factor: 2.38). 08/2010; 19(4):260-7. DOI: 10.1016/j.breast.2010.03.013
Source: PubMed


Recent suggestions by the United States Preventive Task Force to change the longstanding guidelines for screening mammography have raised the issue of cost-effectiveness in regards to breast cancer detection. Given the enormous number of women who have had, or who will be diagnosed with breast cancer, it is essential to maintain the quality of care that has been achieved here in the United States while utilizing a cost-effective approach. The following review attempts a close examination of current methods available for risk assessment, screening and prevention programs. These programs must be carefully considered and analyzed prior to implementing cost-saving changes to current clinical standards that have proven successful in decreasing the mortality from breast cancer throughout the world.

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Available from: Alan B Hollingsworth, Mar 13, 2015
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    • "This type of inappropriateness increases the emotional burden of patients and cost to society in a way that can be avoided to a larger degree with systematic screening mammography use. Cost-effectiveness studies of screening mammography, assuming that mortality was reduced with 30%, predicted a 16000$ cost per year of life expectancy saved for women aged 50 to 69 years [14]–[15]. In Belgium since 2001 both procedures are reimbursed, independently of their indication. "
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    ABSTRACT: Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media. In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries. Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest. 'Evidence' and 'negotiation' are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as well, by separating what is truly innovative and value for money from additional 'waste'.
    PLoS ONE 10/2013; 8(10):e78662. DOI:10.1371/journal.pone.0078662 · 3.23 Impact Factor
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    • "Routine screening mammograms usually target women aged from 50 to 69 years old (Bryant & Mai, 2011). However, many studies have identified 40 years old as an appropriate age to begin annual mammographic screening (Bryant & Mai, 2011; Lebovic et al., 2010). Besides being a screening and diagnostic device, the mammography is also used as a research tool. "
    Mammography - Recent Advances, 03/2012; , ISBN: 978-953-51-0285-4
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    ABSTRACT: Brain activity during interaction with seal robot "Paro" was measured by functional near-infrared spectroscopy (fNIRS). In the pilot study, there were two experimental tasks: Interaction with Paro that was switched ON (Paro ON) and Paro that was switched OFF (Paro OFF) with one minute rest before and after the tasks. The results showed significant activations around the pre-motor area and the supplementary motor area (SMA) during Paro OFF task compared with rest condition before the task. These areas are supposed to be a function of initiating action. This indicates that when participants touched and interacted with Paro, they might intentionally interact. On the other hand, there were significant increased brain activations on both sides of the Sylvian fissure during Paro ON task compared with rest condition before the task. The results suggest that when participants interacted with Paro, they might recognize the emotional gesture expression of Paro. They might communicate with Paro naturally without intention of interaction.
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