Table 1 Study characteristics
Authors | Country | Disease | Screening tools (strategies) | Comparator | Population | Time horizon | Perspective | Discounting | Monetary units | Effectiveness outcome | ICER | Conclusion of base case | Funding | Treatment |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Albright et al. [55] | USA | Group B Streptococci | Universal screening with rectovaginal swab | No screening | Women with a prior cesarean delivery and a current singleton pregnancy planning to undergo a repeat cesarean | Lifetime | Healthcare | 3% | 2015 USD | Neonatal QALYs | Yes | Not CE | NA | Yes |
Aronsson et al. [12] | Sweden | Colorectal cancer (CRC) | 1. Fecal immunochemical test (FIT) twice 2. Colonoscopy (once) 3. FIT every 2 years 4. Colonoscopy every 10 years | No Screening | 60-year-old Swedish | Lifetime | Healthcare | 3% | EUR (no year) | QALYs | No | All strategies were CE vs no screening | SCREESCO study | Yes |
Atkin et al. [18] | UK | Colorectal cancer | 13 different Sttrategies | Each other and “no colonoscopy” | Individuals with intermediate-grade adenomatous polyps | Lifetime | NHS | 4% | 2012–2013 GBP | QALYs, ELYs | Yes | 3-yearly ongoing colonoscopic surveillance without an age cut-off is CE | NIHR | Yes |
Baggaley et al. [75] | UK | HIV | INSTI HIV1/HIV2 rapid antibody test | Not clear | Hackney Borough | 40 years | NHS | 4% | 2012 GBP | QALYs | Yes | Screening is CE | NHS, NIHR | Yes |
Barzi et al. [19] | USA | Colorectal cancer | 13 screening tools: fecal occult blood test, Flex sig, colonoscopy, CT, DNA. | No screening | US population | 35 years | Societal | 3% | USD (no year) | Life years gained | No | Colonoscopy is CE | National Cancer Institute Core | Yes |
Bleijenberg et al. [13] | Netherlands | Frailty | 1. Electronic frailty screening instrument (EFSI) 2. EFSI and nurse-led care program | Usual care | Patients aged 60 or older | 1 year | Societal | 0% | 2012 EUR | QALYs | No | EFSI has high probability of being CE. The combination showed less value for money. | NA | Yes |
Cadier et al. [66] | France and USA | Hepatocellular Carcinoma | Biannual ultrasound + MRI + CT + biopsy | Real life | Patients with diagnosis of compensated cirrhosis | 10 years | Healthcare | 4% | 2015 (Unknown) | Life years gained | Yes | Biannual ultrasound (gold standard) screening is CE | No funding | Yes |
Wrenn et al. [79] | USA | Incidental gallbladder carcinoma | Cholecystectomy | Not clear | Cholecystectomies performed between 06/2009 and 06/2014 | NA | NA | NA | NA | ELYs | No | Selective screening based on risk factors of specimen may be a more CE approach. | University of Vermont Medical Center Department of Surgery | Yes |
Campos et al. [20] | 50 low- and middle-income countries | Cervical cancer | 1. Two-dose human papilloma virus (HPV) vaccination 2. One-time screening + treatment when neededz3. Cervical cancer treatment | Each other | 1. 10-year-old girls2. 35-year-old women3. Women with cervical cancer | Lifetime | Payer | 3% | 2013 USD | DALYs | No | Both HPV vaccination and screening would be very CE | American Cancer Society | Yes |
Chen et al. [45] | China | Hearing loss | Neonatal hearing screening | None | Newborns | 15 and 82 years | NA | 3% | 2012 RMB | 2012 RMB | No | Newborn hearing screening and intervention program in Shanghai is justified in terms of the resource input | National Natural Science Foundation of China | Yes |
Cheng et al. [76] | China | Hepatitis E | 1. Screening (HEV antibody) and vaccination 2. Universal vaccination | No vaccination | 60-year-old cohort | 16 years | Societal | 3% | 2016 USD | QALYs | Yes | Screening and vaccination is the most CE hepatitis E intervention strategy | Chinese National Natural Fund | Yes |
Chevalier et al. [70] | France | Coronary artery disease | Maximal exercise test (ET) | None | Men aged > 35 years, with more than 2 h a week of training | NA | NA | NA | EUR (no year) | Cardiovascular disease cases | No | ET should be targeted at men with at least two cardiovascular risk factors | None | No |
Chowers et al. [21] | Israel | Human immunodeficiency virus (HIV) | Prenatal HIV screening | Current policy | Newborns | 100 years | Payer | 4% | NIS (no year) | QALYs | No | Universal prenatal HIV screening is projected to be cost saving in Israel | NA | Yes |
Coyle et al. [22] | Canada | Cancer | Computed tomography (CT) scan + occult cancer screening | Cancer screening alone | Patients with unprovoked VTE | 12 months | Healthcare | 0% | CAD (no year) | QALYs and Missed cancer case | No | CT scan of the abdomen/pelvis for the screening of occult cancer is not CE | Heart and Stroke Foundation of Canada | No |
Cressman et al. [56] | Canada | Lung cancer | Low-dose computed tomography (LDCT) | Chest radiography | 60-year-olds | 30 years | Societal | 3% | 2015 CAD | QALYs | Yes | High-risk lung cancer screening with LDCT is likely to be considered CE | Terry Fox Research Institute | Yes |
Crowson et al. [23] | USA | Vestibular schwannomas | Non-contrast screening Magnetic resonance imaging (MRI) | Full MRI protocol with contrast | Patients with asymmetric sensorineural hearing loss | NA | 3rd-party payer | NA | USD (no year) | Useful results (True positives and true negatives) | No | A screening MRI protocol is more CE than a full MRI with contrast | None | No |
Devine et al. [24] | Thailand-Myanmar | Perinatal hepatitis B | 1. Hepatitis immunoglobulin (HBIG) after rapid diagnostic tests 2. HBIG after confirmatory test | Vaccination alone | Refugee and migrant population on the Thailand-Myanmar border | From first contact to childbirth | Healthcare | NA | USD (no year) | Perinatal infection of Hepatitis B | Yes | HBIG following rapid diagnostic test is CE | Wellcome-Trust Major Overseas Programme in SE Asia | No |
Devine et al. [46] | Thailand-Myanmar | Plasmodium vivax | G6PD testing | [1] chloroquine alone [2] primaquine without screeningz | Refugee and migrant population on the Thailand-Myanmar border | 1 year | Healthcare | NA | 2014 USD | DALYs | Yes | G6PD RDTs to identify patients with G6PD deficiency before supervised primaquine is likely to provide significant health benefits | Welcome-Trust Major Overseas Programme in SE Asia | Yes |
Ditkowsky et al. [25] | USA | Chlamydia trachomatis | Chlamydia screening | No Screening | Pregnant women aged 15–24 | 1 year | Healthcare | NA | 2015 USD | 2015 USD | No | Prenatal screening for C. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs | None | Yes |
Ethgen et al. [14] | France | Hepatitis C (HCV) | 1. IFN + RBV + PI for F2–F4 2. IFN-based DAAs for F2–F4 3. All-oral, IFN-free DAAs for F2–F4 4. All-oral, IFN-free DAAs for F0–F4 | No intervention | French baby-boomer population (1945–1965 birth cohorts) | 20 years | Healthcare | 4% | EUR (no year) | QALYs, liver-related deaths | No | HCV screening and access to all-oral DAAs is CE | AbbVie | Yes |
Ferguson et al. [69] | Canada | Chronic kidney disease (CKD) | CKD screening | Usual care | Rural Canadian indigenous populations | 45 years | Healthcare | 5% | 2013 CAD | QALYs | Yes | Targeted screening and treatment for CKD is CE | University of Manitoba, CIHR | Yes |
Ferrandiz et al. [26] | Spain | Skin cancer | Clinical teleconsultations (CTC) | CTC + dermoscopic teleconsultation | Patients visiting 5 participating primary care centers because of concern over lesions suggestive of skin cancer | NA | NA | NA | EUR (no year) | Detected cases | No | Dermoscopic images improve the results of an internet-based skin cancer screening system | Health Council of the Regional Government of Andalusia-Spain | No |
Goede et al. [27] | Canada | Colorectal cancer (CRC) | Fecal immunochemical testing (FIT) | Guaiac fecal occult blood testing and no screening | 40-year-old screening participants at average risk of CRC | Varied (20 to 45 years) | Healthcare | 3% | 2013 CAD | QALYs | Yes | FIT was the most CE strategy | Ontario Ministry of Health and Long-Term Care | Yes |
Gray et al. [47] | UK | Breast cancer | 1. Risk 1 2. Risk 2 3. Masking 4. Risk 1 + masking | No screening | Women eligible for a National Breast Screening Program (NBSP) | Lifetime | NHS | 4% | 2014 GBP | QALYs | Yes | Risk stratified NBSPs were relatively CE compared to the UK NBSP | FP7-HEALTH-2012-INNOVATION-1 | Yes |
Gupta et al. [28] | USA | Cystic lung disease | High-resolution computed tomographic (HRCT) imaging | no HRCT screening | Patients with Spontaneous Pneumothorax | NA | Societal | 3% | 2014 USD | QALYs | Yes | HRCT image screening is CE | None | Yes |
Haukaas et al. [44] | Norway | Tuberculosis (TB) | 1. TST + IGRA 2. IGRA 3. IGRA for risk | No screening | Immigrants under 35 years of age from countries with a high incidence of TB | 10 years | Healthcare | 4% | 2013 EUR | Avoided TB cases | Yes | IGRA is the optimal algorithm at a threshold above €28,400 | None | No |
Heidari et al. [29] | Iran | Hearing loss | 1. AABR 2. OAE | Each other | Newborns | 1 year | Healthcare | NA | IRR (no year) | Detected cases | No | AABR is the CE alternative compared to OAE | I.R. Iran’s National Institute of Health Research | No |
Horn et al. [30] | USA | Substance abuse | 1. Minimal screening 2. Screening, assessment and referral 3. 2 + brief intervention and follow-up | Each other | Patients from emergency departments of 6 clinical sites across the US | 1 year | NA | NA | 2013 USD | 2013 USD | No | Resources could be better utilized supporting other health interventions. | NA | Yes |
Htet et al. [71] | Myanmar | Pulmonary tuberculosis | Interventional model | Conventional model | Household contacts | 5 months | NA | NA | USD (no year) | Detected cases | Yes | The interventional model was more CE than the modified conventional model. | NA | No |
Hunter et al. [31] | USA | Breast cancer | Digital breast tomosynthesis | Full-field digital mammography | Patients undergoing screening mammography | 1 year | NA | NA | 2014 USD | Cancer detected | No | DBT is a cost-equivalent or potentially CE alternative to FFDM | NA | No |
John et al. [48] | India | Glaucoma | Community screening | No screening | people aged 40–69 years in urban areas in India | 10 years | Healthcare | 3% | 2015 INR | Additional treated cases, QALYs | Yes | A community screening program is likely to be CE | NZAID Commonwealth Scholarship | Yes |
Keller et al. [68] | Australia | Prostate cancer | Serum prostate specific antigen (PSA) test every 2 years | Opportunistic screening | Australian male cohort aged between 50 and 69 years. | 20 years | Healthcare | 5% | 2015 AUD | QALYs | Yes | PSA-based screening is not CE | University of Queensland | Yes |
Kievit et al. [32] | Netherlands | Cardiovascular (CV) disease | CV risk profiling | No screening | Patients with rheumatoid arthritis (RA) | 10 years | Medical | 4% for costs and 1.5% for outcomes | EUR (no year) | QALYs | No | Screening for CV events in RA patients was estimated to be CE | NA | Yes |
Kim et al. [49] | South Korea | Hepatitis C | One-time screening | No screening | People aged 40–70 | 5 years | Healthcare | 5% | USD (no year) | QALYs | Yes | HCV screening and treatment is likely to be highly CE | Bristol-Myers Squibb Pharmaceuticals | Yes |
Kim et al. [63] | USA | Human Papillomavirus | 1. Cytology 2. HPV test 3. Co-test | Each other | US women | 10–44 years | Societal | 3% | USD (no year) | QALYs | No | Screening can be modified to start at later ages and at lower frequencies | National Cancer Institute of the National Institutes of Health | No |
Lapointe-Shaw et al. [72] | USA | Carbapenemase-producing Enterobacteriaceae | Rectal swab screening | No screening | 65-year-old patients admitted to a general medical inpatient service. | 19.2 years | US Hospital | 3% | 2016 USD | QALYs | Yes | Screening inpatients for CPE carriage is likely CE | None | No |
Lew et al. [58] | Australia | Colorectal cancer | Projected iFOBT screening | No screening | People aged 50–74 | 24 years | Health services | 5% | 2015 AUD | Life years gained | No | The program is highly CE | Cancer Institute NSW and Cancer Council NSW | Yes |
Liow et al. [77] | USA | Bone malignancies | Routine femoral head histopathology | None | Patients that underwent primary total hip arthroplasty | 4 years | NA | NA | 2016 USD | QALYs | Yes | Routine femoral head histopathology may be CE | NA | Yes |
Mo et al. [15] | China | Cervical cancer | 1. Liquid-based cytology test + HPV DNA test 2. Pap smear cytology test + HPV DNA test 3. Visual inspection with acetic acid | No intervention | Adolescent girls (Above 12 years old) | Lifetime | Societal | 3% | 2015 USD | QALYs | Yes | The HPV4/9 vaccine with current screening strategies was highly CE | Japan Society for the Promotion of Sciences | Yes |
Morton et al. [50] | UK | Breast cancer | Mammography | No screening | Females over 45 years old | 20 years | NHS | 4% | 2016 GBP | QALYs | Yes | Calculations suggested that breast cancer screening is CE | NA | Yes |
Mullie et al. [51] | Canada and USA | Latent tuberculosis | 1. Tuberculin skin test 2. QuantiFERON®-TB-Gold In-Tube | Each other | Healthcare workers | 20 years | Healthcare | 3% | 2015 CAD | QALYs | Yes | Annual tuberculosis screening appears poorly CE | McGill University, CIHR | Yes |
Petry et al. [16] | Germany | Human papillomavirus | 1. HPV test followed by Pap cytology 2. HPV test followed by cytology 3. HPV test followed by colposcopy 4. Co-testing with HPV and Pap | Pap cytology | Women aged 30–65 | 10 years | NA | 3% | EUR (no year) | Avoided deaths | No | The greatest clinical impact was achieved with primary HPV screening (with genotyping) followed by colposcopy | Hoffmann-La Roche | Yes |
Phisalprapa et al. [33] | Thailand | Nonalcoholic fatty liver disease | Ultrasonography screening | No screening | 50-year-old metabolic syndrome patients | Lifetime | Societal | 3% | 2014 USD | QALYs | Yes | Ultrasonography screening for NAFLD with intensive weight reduction program is CE | NA | Yes |
Pil et al. [59] | Belgium | Skin Cancer | Total body skin examination (TBSE) | Lesion-directed screening | Belgian population over 18 years of age | 50 years | Societal | Outcomes at 1.5% and costs at 3% | EUR (no year) | QALYs | Yes | 1-time TBSE is the most CE strategy | The LEO Foundation and the Belgian Federation Against Cancer | Yes |
Prusa et al. [80] | Austria | Toxoplasmosis | Prenatal screening | No screening | Birth cohorts from 1992 to 2008 and | 20 years | Societal | 3% | 2012 Euro | Life and productivity loss | No | Cost savings of prenatal screening for toxoplasmosis and treatment are outstanding | None | Yes |
Requena-Mendez et al. [34] | All Europe | Chagas disease | T. cruzi serological screening | No screening | Latin American adults living in Europe | Lifetime | Healthcare | 3% | EUR (no year) | QALYs | YES | Screening for Chagas disease in asymptomatic Latin American adults living in Europe is a CE strategy. | European Commission 7th Framework Program | Yes |
Roberts et al. [60] | Australia | Rheumatic heart disease | Echocardiographic screening | Screening every other year and no screening | Indigenous Australian Children | 40 years | Healthcare | 5% | 2013 AUD | DALYs, heart failure, surgery | Yes | Echocardiographic screening is CE assuming that RHD can be detected ≥ 2 years earlier by screening | University of Western Australia | Yes |
Rodriguez-Perez et al. [64] | Spain | Type 2 diabetes | DIABSCORE | HbA1c or blood glucose | Adult primary care patients in Spain | NA | NA | NA | EUR (no year) | Cases detected | No | DIABSCORE is a CE and valid method for opportunistic screening of type 2 diabetes | Carlos III Health Institute | No |
Saito et al. [35] | Japan | Gastric cancer | ABC method: HPA and measuring serum PG concentrations | Annual endoscopic screening | 50-year-old Japanese individuals who have high gastric cancer incidence and mortality who had not undergone H. pylori eradication | 30 years | Healthcare | 2% | 2014 USD | Lives saved and QALYs | Yes | ABC method cost less and saved more lives | Niigata University of Health and Welfare | Yes |
Schiller-Fruehwirth et al. [36] | Austria | Breast cancer | 1. Organized screening 2. Opportunistic screening | No screening | 40-year-old asymptomatic women | Lifetime | Healthcare | 3% | 2012 EUR | Life years gained | Yes | The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria | Main Association of Social Security Institutions | Yes |
Selvapatt et al. [65] | UK | Hepatitis C | HCV testing | No screening | All persons attending a London DTU | Lifetime | Healthcare | 4% | 2013 GBP | ELYs, QALYs | Yes | Concludes cost effectiveness of outreach testing and treatment of hepatitis | Biomedical Research Council to Imperial College Department of Hepatology | Yes |
Sharma et al. [61] | Lebanon | Cervical cancer | 1. Cytology 2. HPV DNA screen | No screening | Women aged 25–65 years | NA | Societal | 3% | I$ (no year) | Years of life saved | Yes | Increasing coverage to 50% with extended screening intervals provides greater health benefits | None | Yes |
Smit et al. [73] | Belgium | Tuberculosis | X-ray screening | No screening | Risk groups: prisoners, youth in detention centers, undocumented migrants | 1 year | Flemish Agency for Care and Health | 0% | 2013–14 EUR | Detected cases | No | Tuberculosis screening is relatively expensive | Flemish Agency for Care and Health | No |
Ten Haaf et al. [52] | Canada | Lung cancer | Computer tomography | No screening | Persons born between 1940 and 1969 | Lifetime | Healthcare | 3% | 2015 CAD | Life years gained, false positive screen | Yes | Lung cancer screening with stringent smoking eligibility criteria can be CE | Clinical Evaluative Sciences | Yes |
Teng et al. [62] | New Zealand | Helicobacter pylori infection, gastric cancer | 1. Fecal antigen 2. Serology | Current practice | Total population and targeted Māori (25–69 years old) | Lifetime | Healthcare | 3% | 2011 USD | QALYs | Yes | Screening was likely to be CE particularly for indigenous populations | Health Research Council of New Zealand | Yes |
Tjalma et al. [37] | Belgium | Cervical cancer | Dual stain cytology | Cytology | Women between 25 and 65 years of age | 60 years | Healthcare | NA | EUR (no year) | QALYs | Yes | Diagnostic cytology benefits all stakeholders involved in cervical cancer screening | NA | Yes |
Tufail et al. [38] | UK | Diabetic retinopathy | Automated diabetic retinopathy image assessment systems (ARIAS) | Human graders | Patients with a diagnosis of diabetes mellitus who attended their annual visit at the diabetes eye-screening program | NA | NHS | 4% | 2013–2014 GBP | Appropriate screening outcome | No | ARIAS have the potential to reduce costs and to aid delivery of DR screening | Novartis | No |
Meulen et al. [39] | Netherlands | Colorectal cancer (CRC) | 1. Fecal immunology test 2. gFOBT 3. Sigmoidoscopy | Each other | Screening-naive subjects ages 50 to 74 years, living in the southwest of the Netherlands | Lifetime | Healthcare | 3% | 2012 EUR | Positivity rates, detection of adenoma and CRC, QALYs | Yes | Screening stratified by gender is not more CE than uniform FIT screening | NA | Yes |
van Katwyk et al. [53] | Canada | Diabetic retinopathy | Extended coverage of diabetic eye examination | Usual care | Prince Edward Island residents over 45 years of age who had diabetes | 30 years | Healthcare | 5% | 2015 CAD | QALYs | Yes | Extending public health coverage to eye examinations by optometrists is CE | CIHR | Yes |
van Luijt et al. [67] | Norway | Breast cancer | Mammography | No screening | Norway female population | Lifetime | Societal | 4% | 2014 NOK | QALYs | No | The NBCSP is a highly CE measure to reduce breast cancer specific mortality | Research Council Norway | Yes |
Wang et al. [17] | China | Chronic kidney disease | 1. Day 1 2. Random 3. Day 1 + random 4. Day 1+ random + day 2 | Each other | Outpatients admitted to Peking University First Hospital from January 2013 to January 2014 | 30 years | Societal | 5% | CNY (no year) | QALYs | Yes | Combining two first morning urine samples and one randomized spot urine sample is CE | National Key Technology R&D Program of the Ministry of Science and Technology | Yes |
Welton et al. [40] | England and Wales | Atrial fibrillation | 1. Single systematic population screen 2. Single systematic opportunistic screen | No screening | General population in England and Wales | Lifetime | NHS | 4% | 2015 GBP | QALYs | Yes | Population-based screening is likely to be CE | NIHR | Yes |
Whittington et al. [74] | USA | Staphylococcus aureus infection | 1. Universal decolonization 2. Targeted decolonization 3. Screening and isolation | Each other | Hypothetical cohort of adults admitted to the Intensive care unit. | 1 year | Hospital | NA | 2015 USD | QALYs | Yes | This study supports updating the standard practice to a decolonization approach. | NA | No |
Williams et al. [41] | USA | Prosthetic joint infection | 1. 4 swabs decolonization 2. 2 swabs 3. Nasal swab alone | No screening and decolonization | Hip and knee replacement patients | NA | Societal | NA | 2016 USD | Cases of prosthetic joint infections | No | The 2-swab and universal-decolonization strategy were most CE | None | Yes |
Yang et al. [54] | Taiwan | Lung cancer | 1. Computed tomography (CT) 2. Radiography | No screening | Smokers between 55 and 75 years of age | Lifetime | Healthcare | 3% | 2013 USD | QALYs | Yes | Low-dose CT screening for lung cancer among high-risk smokers would be CE in Taiwan | Ministry of Science and Technology, and the National Cheng Kung University Hospital | Yes |
Yarnoff et al. [42] | USA | Chronic kidney disease (CKD) | CKD risk scores | No screening | US population | Lifetime | Healthcare | 3% | 2010 USD | QALYs | Yes | CKD risk scores may allow clinicians to cost-effectively identify a broader population for CKD screening | Centers for Disease Control and Prevention | Yes |
Yoshimura et al. [78] | Japan | Osteoporosis | Screening and alendronate therapy | No screening and no therapy | Postmenopausal women over 60 years | 5 years | Healthcare | 3% | USD (no year) | QALYs | Yes | Screening and treatment would be CE for Japanese women over 60 years. | Ministry of Education, Culture, Sports, Science and Technology | Yes |
Zimmermann et al. [43] | Kenya | Cervical cancer | 1. Visual inspection with acetic acid (VIA) 2. Papanicolaou smear 3. Testing for human papillomavirus (HPV) | Cryotherapy without screening | Hypothetical cohort of 38-year-old women | Lifetime | Societal | 3% | 2014 USD | ELYs | No | VIA was most CE unless HPV could be reduced to a single visit | NA | Yes |