Evidence underpinning benefits and harms of earlier cancer diagnosis: a systematic review of economic evaluations

Problem

The early diagnosis of cancer has been an area of significant investment in recent years, with the overarching ambition of detecting cancer at a more easily treated stage, thus improving quality of life and survival. Economic evaluations of interventions that facilitate earlier diagnosis of cancer (e.g. screening, novel diagnostics, revised diagnostic pathways, and cancer awareness campaigns) require evidence on the benefits and harms of detecting cancer earlier to estimate health outcomes and costs. This study is a systematic review of the evidence used to underpin the benefits and harms of earlier cancer diagnosis in such studies.

Approach

We have searched the following electronic databases: Medline, Embase, Web of Science and the CRD HTA Database. Titles and abstracts of the studies retrieved during the database search are being screened, split evenly between two reviewers (LS and BS), with a further 10% double screened by each of these reviewers. A PRISMA flow chart will be developed to show the different stages of the screening process. Studies are included if they report an economic evaluation of an intervention that facilitates the earlier diagnosis of cancer. Studies published prior to 2015, non-English papers, and conference abstracts will be excluded. Data will be extracted on the evidence underpinning any assumed benefits or harms arising from the earlier diagnosis of cancer. Specially, the evidence informing the reduced time to diagnosis and the estimated benefits and harms resulting from this will be summarised and categorised using a hierarchy of evidence framework. In the absence of evidence, a summary of the methods used to estimate the consequences of early diagnosis will be provided e.g. calibration, expert elicitation. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist will be used to assess the overall quality of the economic evaluations.

Findings

The results of the systematic review will be presented and the broader implications of the quality of the evidence underpinning the early diagnosis will be discussed.

Consequences

The findings from this study will be relevant for primary care and have implications for the development of interventions aimed at promoting the earlier diagnosis of cancer, of which GPs play a crucial role.