Open Access Research article

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

Misericordia Carles1, Ester Vilaprinyo2, Francesc Cots2, Aleix Gregori1, Roger Pla3, Rubén Román2, Maria Sala2, Francesc Macià2, Xavier Castells2 and Montserrat Rue4*

Author Affiliations

1 Economics Department, Rovira i Virgili University, Reus, Catalonia, Spain

2 Evaluation and Clinical Epidemiology Department, Parc de Salut Mar and CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Catalonia, Spain

3 Terres de l'Ebre Region, Catalan Institute of Health, Catalonia, Spain

4 Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Catalonia, Spain

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BMC Cancer 2011, 11:192  doi:10.1186/1471-2407-11-192

Published: 23 May 2011



Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care.


We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios.


Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY.


A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.