An early economic evaluation of active surveillance for low-risk ductal carcinoma in situ

Aim: Perform early economic evaluation comparing active surveillance (AS) to surgery for women with low-risk ductal carcinoma in situ, a precursor of invasive breast cancer. Materials & methods: A 10-year incremental costs (Euro) and quality-adjusted life years (QALYs) were compared between a simulated cohort of women undergoing breast conserving surgery +/- radiotherapy, and a cohort with a low-risk subgroup undergoing AS using a semi-Markov model. Scenario and headroom analyses evaluated a better-performing biomarker to select low-risk women for AS. Results: AS resulted in lower costs and survival, but higher QALYs (0.40). Scenario analyses maintained survival outcomes and maximized QALYs. Conclusion: AS for low-risk ductal carcinoma in situ is cost-effective, but a better-performing biomarker to select low-risk women can maximize quality-adjusted outcomes.