Background: A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. Methods: From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs. Results: For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56–64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676). Conclusion: Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.
背景：在PERSPECTIVE I&I项目框架内，加拿大安大略省开展了一项前瞻性队列研究，旨在评估与乳腺癌风险评估和筛查相关的医疗资源使用情况及成本，并按风险水平分层分析总体医疗成本。方法：2019年7月至2022年12月期间，1997名50至70岁女性在安大略省同意接受风险评估，并获得乳腺癌风险等级及个性化筛查行动计划。风险分层筛查相关活动的平均成本包括风险评估、筛查及诊断费用。临床评估科学研究所（ICES）的GETCOST宏程序用于评估医疗系统的平均总体成本。结果：在1997名参与者中，83.3%、14.4%和2.3%分别被评估为平均风险、高于平均风险和高风险（中位年龄[四分位距]：60[56-64]岁）。风险分层采用经验证的多因素CanRisk预测工具，该工具整合了家族史信息、多基因风险评分（PRS）、乳腺密度及已确立的生活方式/激素风险因素。随着风险等级升高，人均遗传咨询次数、乳腺X线摄影和磁共振检查次数相应增加。2022年加元计价的筛查相关平均成本显示：高风险参与者成本最高（905±269加元），高于平均风险者为580±192加元，平均风险者为521±163加元。在乳腺癌筛查相关成本中，所有风险组别的最大成本负担均为风险评估成本，其次为诊断与筛查总成本。参与者人均总体医疗成本平均值（±标准差）显示：平均风险组最高（6311±19641加元），其次为高于平均风险组（5391±8325加元）和高风险组（5169±7676加元）。结论：尽管高风险参与者承担最高的风险分层筛查相关成本，但其总体医疗利用成本与其他风险水平相当。本研究强调将风险分层整合至筛查路径的重要性，以支持在更早、更可治疗的阶段发现乳腺癌，从而降低医疗系统成本与总体负担。
肿瘤(癌症)患者之家