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META-ANALYSIS METHODS IN THE COST-EFFECTIVENESS
ANALYSIS OF MAMMOGRAPHY SCREENING
by
Danielle Christine Zammit
____________________________________________________________________
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PHARMACEUTICAL ECONOMICS AND POLICY)
May 2007
Copyright 2007 Danielle Christine Zammit
Object Description
| Title | Meta-analysis methods in the cost-effectiveness analysis of mammography screening |
| Author | Zammit, Danielle Christine |
| Author email | zammit@usc.edu |
| Degree | Doctor of Philosophy |
| Document type | Dissertation |
| Degree program | Pharmaceutical Economics & Policy |
| School | School of Pharmacy |
| Date defended/completed | 2007-03-06 |
| Date submitted | 2007 |
| Restricted until | Unrestricted |
| Date published | 2007-04-23 |
| Advisor (committee chair) | Gauderman, W. James |
| Advisor (committee member) |
Sugar, Catherine Globe, Denise Hay, Joel W. |
| Abstract | The objectives of this research were: to conduct quality-weighted random effects meta-analysis of the effect of mammography (MM) screening on breast cancer (BC) mortality, to create a framework to analyze the cost-effectiveness of MM screening, designed specifically to isolate the effect of MM on life expectancy (LE) with BC, and to run full sensitivity analyses of this model.; Methods: The relative risk (RR) of BC mortality in screened vs. control groups was estimated by incorporating a study-specific quality weight into inverse-variance weighted random effects (RE) analysis. Cost-effectiveness of MM screening vs. no screening was analyzed on a base case of a white female population being screened annually from the age of 40, on a lifetime horizon from the societal perspective. The RR of BC mortality was used to estimate life expectancy with BC in screened women. Direct and indirect costs included MM, its workup and BC management. Extensive sensitivity analyses were conducted.; Results: Significant 20% and 22% reductions in BC mortality were observed in screened women of any age and above age fifty [RR: 0.78(95%CI=0.70-0.88)] respectively. CIs were narrower than those from RE analysis. Under fifty, the result reduced to a fixed effects analysis: 0.84(95%CI=0.73-0.97). No trend of effect with study quality was observed, although under fifty, seven studies were pooled before a significant effect was observed. MM is most cost-effective at age 60, (ICER: $38,876/QALY), being slightly less so at 40 (ICER: $47,991/QALY). The ICER (incremental cost-effectiveness ratio) increases steadily after age 65, reaching its highest estimation at age 80. The model was very sensitive to the RR of BC mortality with MM. SA also showed sensitivity to discount rate, but relative robustness to other parameters.; Conclusions: Quality scores may be used in a meta-analysis to account for between-study variance due to heterogeneity. Evidence of MM benefit under 50 may depend on the number and quality of studies included. The most cost-effective program tested was to start annual MM at age 40, switching to 2-year intervals at 50, and stopping at age 70. This framework can be used for the cost-effectiveness analysis of screening recommendations, and future policy analyses. |
| Keyword | mammography; cost-effectiveness analysis; meta-analysis |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Type | texts |
| Legacy record ID | usctheses-m440 |
| Rights | Zammit, Danielle Christine |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | http://www.usc.edu/isd/libraries/services/ask_a_librarian/email/ |
| Filename | etd-Zammit-20070423 |
| Archival file | uscthesesreloadpub_Volume48/etd-Zammit-20070423.pdf |
Description
| Title | Page 1 |
| Full text | META-ANALYSIS METHODS IN THE COST-EFFECTIVENESS ANALYSIS OF MAMMOGRAPHY SCREENING by Danielle Christine Zammit ____________________________________________________________________ A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (PHARMACEUTICAL ECONOMICS AND POLICY) May 2007 Copyright 2007 Danielle Christine Zammit |
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