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Poelhekken K, Lin Y, Greuter MJW, van der Vegt B, Dorrius M, de Bock GH. The natural history of ductal carcinoma in situ (DCIS) in simulation models: A systematic review. Breast 2023; 71:74-81. [PMID: 37541171 PMCID: PMC10412870 DOI: 10.1016/j.breast.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE Assumptions on the natural history of ductal carcinoma in situ (DCIS) are necessary to accurately model it and estimate overdiagnosis. To improve current estimates of overdiagnosis (0-91%), the purpose of this review was to identify and analyse assumptions made in modelling studies on the natural history of DCIS in women. METHODS A systematic review of English full-text articles using PubMed, Embase, and Web of Science was conducted up to February 6, 2023. Eligibility and all assessments were done independently by two reviewers. Risk of bias and quality assessments were performed. Discrepancies were resolved by consensus. Reader agreement was quantified with Cohen's kappa. Data extraction was performed with three forms on study characteristics, model assessment, and tumour progression. RESULTS Thirty models were distinguished. The most important assumptions regarding the natural history of DCIS were addition of non-progressive DCIS of 20-100%, classification of DCIS into three grades, where high grade DCIS had an increased chance of progression to invasive breast cancer (IBC), and regression possibilities of 1-4%, depending on age and grade. Other identified risk factors of progression of DCIS to IBC were younger age, birth cohort, larger tumour size, and individual risk. CONCLUSION To accurately model the natural history of DCIS, aspects to consider are DCIS grades, non-progressive DCIS (9-80%), regression from DCIS to no cancer (below 10%), and use of well-established risk factors for progression probabilities (age). Improved knowledge on key factors to consider when studying DCIS can improve estimates of overdiagnosis and optimization of screening.
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Affiliation(s)
- Keris Poelhekken
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, P.O. Box 30 001, FA40, 9700, RB, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, PO Box 30.001, EB44, 9700, RB, Groningen, the Netherlands.
| | - Yixuan Lin
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, P.O. Box 30 001, FA40, 9700, RB, Groningen, the Netherlands
| | - Marcel J W Greuter
- University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, PO Box 30.001, EB44, 9700, RB, Groningen, the Netherlands
| | - Bert van der Vegt
- University of Groningen, University Medical Center Groningen, Groningen, Department of Pathology and Medical Biology, PO Box 30.001, 9700, RB, Groningen, the Netherlands
| | - Monique Dorrius
- University of Groningen, University Medical Center Groningen, Groningen, Department of Radiology, PO Box 30.001, EB44, 9700, RB, Groningen, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, P.O. Box 30 001, FA40, 9700, RB, Groningen, the Netherlands
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Jiang J, Jiang S, Ahumada-Canale A, Chen Z, Si L, Jiang Y, Yang L, Gu Y. Breast Cancer Screening Should Embrace Precision Medicine: Evidence by Reviewing Economic Evaluations in China. Adv Ther 2023; 40:1393-1417. [PMID: 36800077 PMCID: PMC10070309 DOI: 10.1007/s12325-023-02450-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g. mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective. We aimed to review the economic evaluations of breast cancer screening in China to provide an information summary for future research on this topic. We searched the literature to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies satisfying our inclusion criteria. Four articles examined mammography while the rest investigated multigene testing. The existing breast cancer screening programmes were found to be cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Contextual factors, such as data absence, urban-rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis. Multigene testing was found to be cost-effective and has a promising population impact among all women with breast cancer in China. Future research should investigate the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings.
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Affiliation(s)
- Jingjing Jiang
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
- Faculty of Humanities and Social Sciences, School of Economics, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
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Dan Q, Zheng T, Liu L, Sun D, Chen Y. Ultrasound for Breast Cancer Screening in Resource-Limited Settings: Current Practice and Future Directions. Cancers (Basel) 2023; 15:cancers15072112. [PMID: 37046773 PMCID: PMC10093585 DOI: 10.3390/cancers15072112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Breast cancer (BC) is the most prevalent cancer among women globally. Cancer screening can reduce mortality and improve women’s health. In developed countries, mammography (MAM) has been primarily utilized for population-based BC screening for several decades. However, it is usually unavailable in low-resource settings due to the lack of equipment, personnel, and time necessary to conduct and interpret the examinations. Ultrasound (US) with high detection sensitivity for women of younger ages and with dense breasts has become a supplement to MAM for breast examination. Some guidelines suggest using US as the primary screening tool in certain settings where MAM is unavailable and infeasible, but global recommendations have not yet reached a unanimous consensus. With the development of smart devices and artificial intelligence (AI) in medical imaging, clinical applications and preclinical studies have shown the potential of US combined with AI in BC screening. Nevertheless, there are few comprehensive reviews focused on the role of US in screening BC in underserved conditions, especially in technological, economical, and global perspectives. This work presents the benefits, limitations, advances, and future directions of BC screening with technology-assisted and resource-appropriate strategies, which may be helpful to implement screening initiatives in resource-limited countries.
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Affiliation(s)
- Qing Dan
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Tingting Zheng
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Yun Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
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Xia C, Chen W. The NCC mathematical modeling framework for decision-making of six major cancers. JOURNAL OF THE NATIONAL CANCER CENTER 2022. [DOI: 10.1016/j.jncc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wang J, Greuter MJ, Zheng S, van Veldhuizen DW, Vermeulen KM, Wang Y, Lu W, de Bock GH. Assessment of the Benefits and Cost-Effectiveness of Population-Based Breast Cancer Screening in Urban China: A Model-Based Analysis. Int J Health Policy Manag 2022; 11:1658-1667. [PMID: 34273933 PMCID: PMC9808213 DOI: 10.34172/ijhpm.2021.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To decrease the burden of breast cancer (BC), the Chinese government recently introduced biennial mammography screening for women aged 45-70 years. In this study, we assess the effectiveness and cost-effectiveness of implementing this programme in urban China using a micro-simulation model. METHODS The 'Simulation Model on radiation Risk and breast cancer Screening' (SiMRiSc) was applied, with parameters updated based on available data for the Chinese population. The base scenario was biennial mammography screening for women aged 45-70 years, and this was compared to a reference population with no screening. Seven alternative scenarios were then simulated by varying the screening intervals and participant ages. This analysis was conducted from a societal perspective. The discounted incremental cost-effectiveness ratio (ICER) was compared to a threshold of triple the gross domestic product (GDP) per life years gained (LYG), which was 30 785 USD/LYG. Univariate sensitivity analyses were conducted to evaluate model robustness. In addition, a budget impact analysis was performed by comparing biennial screening with no screening at a time horizon of 10 years. RESULTS Compared with no screening, the base scenario was cost-effective in urban China, giving a discounted average cost-effectiveness ratio (ACER) of 17 309 USD/LYG. The model was most sensitive to the cost of mammography per screen, followed by mean size of self-detected tumours, mammographic breast density and the cumulative lifetime risk of BC. The efficient frontier showed that at a threshold of 30 785 USD/LYG, the base scenario was the optimal scenario with a discounted ICER of 25 261 USD/LYG. Over 10 years, screening would incur a net cost of almost 38.1 million USD for a city with 1 million citizens. CONCLUSION Compared to no screening, biennial mammography screening for women aged from 45-70 is cost-effective in urban China.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel J.W. Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Senshuang Zheng
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniëlle W.A. van Veldhuizen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives. Cancers (Basel) 2022; 14:cancers14174218. [PMID: 36077752 PMCID: PMC9454998 DOI: 10.3390/cancers14174218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/09/2022] Open
Abstract
Simple Summary Nearly all breast cancer patients survive for more than five years when the tumor is found early and in the localized stage. Regular clinical breast examinations, mammograms, and monthly self-exams of the breasts all contribute to early detection. However, late-stage breast cancers are common in many Asian countries. Low-income countries suffer from a lack of resources for breast cancer screening. High-income countries, on the other hand, are not benefiting fully from national breast screening programs due to an underutilization of the preventive healthcare services available. Existing reviews on Asian breast cancers are heavily focused on risk factors. The question of whether we should adopt or adapt the knowledge generated from non-Asian breast cancers would benefit from an extension into screening guidelines. In addition, several Asian countries are piloting studies that move away from the age-based screening paradigm. Abstract Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.
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Lin YT, Chen Y, Liu TX, Kuang F, Huang P. Cost-Effectiveness Analysis of Camrelizumab Immunotherapy versus Docetaxel or Irinotecan Chemotherapy as Second-Line Therapy for Advanced or Metastatic Esophageal Squamous Cell Carcinoma. Cancer Manag Res 2021; 13:8219-8230. [PMID: 34754242 PMCID: PMC8572144 DOI: 10.2147/cmar.s335515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/24/2021] [Indexed: 01/18/2023] Open
Abstract
Purpose The aim of this study was to assess the cost-effectiveness of camrelizumab immunotherapy versus docetaxel or irinotecan chemotherapy as second-line therapy for advanced esophageal squamous cell carcinoma (ESCC), which was evaluated in the ESCORT trial. Materials and Methods A partitioned survival model was developed to reflect the costs and effectiveness of the ESCORT trial. The clinical efficacy data, safety data, and health-related costs and utilities were derived from published data from clinical trials or health administration departments in China. Adverse event-related costs, drug administration, and other expenses were derived from a single center of Fujian Medical University Cancer Hospital in 2021. All survival analyses were performed with SPSS software. Overall survival was estimated with the Kaplan-Meier method, and progression-free survival was estimated with the life table method. Sensitivity analyses were conducted to assess the uncertainty of the model. Incremental cost, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were calculated. Results Camrelizumab therapy had 0.232 QALYs at an incremental cost of USD$9959.44 compared with the chemotherapy group with 0.158 QALYs at an incremental cost of USD$8601.67. The ICER was USD$18393.12/QALY. Probabilistic sensitivity analyses showed that when the willingness-to-pay threshold reached USD$31200/QALY, which is nearly three times the Chinese gross domestic product per capita, camrelizumab had an 80% possibility of being cost-effective versus docetaxel or irinotecan chemotherapy. Conclusion Camrelizumab is a cost-effective option compared with docetaxel or irinotecan chemotherapy in patients with advanced ESCC as second-line therapy in China.
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Affiliation(s)
- Ying-Tao Lin
- Administration Office of Drug Clinical Trial, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Ying Chen
- Management Office of Science and Technology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, People's Republic of China
| | - Tian-Xiu Liu
- Department of Thoracic Radiotherapy, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, People's Republic of China
| | - Fang Kuang
- Administration Office of Drug Clinical Trial, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Ping Huang
- Administration Office of Drug Clinical Trial, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
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Kejela S. Cost-effectiveness of screening mammography in a low income country: a Markov simulation analysis. BMC Med Imaging 2021; 21:162. [PMID: 34727883 PMCID: PMC8564986 DOI: 10.1186/s12880-021-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background Breast cancer is the most common cancer diagnosed in women. Screening mammography is the only imaging screening study for breast cancer with a proven. mortality benefit. This study aims to analyze the cost-effectiveness of screening mammography in Ethiopia. Methods Multistate Markov model was used for computer simulation to estimate cost and health benefits of screening mammography interventions for age-group of 40–49 years and 50–59 years. The cost-effectiveness analysis was made for 4 policies based on where the screening mammography procedures were conducted: government institution only, the private institution only, 50% ratio for each, and 10% private institution policy. Outputs were expressed in total cost, life-years gained (LYG) incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB). Results All 4 policies of annual screening mammography failed to achieve acceptable ICER and lead to a net loss in INMB. The lowest ICER value was for government institution-only policy with 3510.3 USD/LYG and 3224.9 USD/LYG both above the cost-effectiveness threshold of 2808.5 USD. The cost per single death averted for each group was 110,206.7 USD and 77,088.2 USD for age-group 40–49 years and 50–59 years respectively. Conclusion Screening mammography could not be shown to be cost-effective in Ethiopia with the current low cost-effectiveness threshold. Alternative screening approach like annual clinical breast examination may need to be investigated.
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Affiliation(s)
- Segni Kejela
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Lei S, Zheng R, Zhang S, Chen R, Wang S, Sun K, Zeng H, Wei W, He J. Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030. Cancer Biol Med 2021; 18:j.issn.2095-3941.2020.0523. [PMID: 34002584 PMCID: PMC8330522 DOI: 10.20892/j.issn.2095-3941.2020.0523] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/09/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015. The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies. METHODS The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry. Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015. A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030. RESULTS Approximately 303,600 new cases of breast cancer (205,100 from urban areas and 98,500 from rural areas) and 70,400 breast cancer deaths (45,100 from urban areas and 24,500 from rural areas) occurred in China in 2015. Urban regions of China had the highest incidence and mortality rates. The most common histological subtype of breast cancer was invasive ductal carcinoma, followed by invasive lobular carcinoma. The age-standardized incidence and mortality rates increased by 3.3% and 1.0% per year during 2000-2015, and were projected to increase by more than 11% until 2030. Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3% and 22.9%, whereas deaths are predicted to increase by 13.1% and 40.9%, respectively. CONCLUSIONS The incidence and mortality of breast cancer continue to increase in China. There are no signs that this trend will stop by 2030, particularly in rural areas. Effective breast cancer prevention strategies are therefore urgently needed in China.
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Affiliation(s)
- Shaoyuan Lei
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Rongshou Zheng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Siwei Zhang
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Ru Chen
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Shaoming Wang
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Kexin Sun
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Hongmei Zeng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Wenqiang Wei
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
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Loong HH, Wong CKH, Leung LKS, Chan CPK, Chang A, Zhou ZY, Xie J, Gibbs M. Cost-effectiveness analysis of ceritinib vs. crizotinib in previously untreated anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) in Hong Kong. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:50. [PMID: 33292314 PMCID: PMC7648263 DOI: 10.1186/s12962-020-00244-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Lower-dose ceritinib (450 mg) once-daily with food was approved in 2018 in Hong Kong (HK) for first-line treatment of patients with anaplastic lymphoma kinase-positive (ALK +) advanced non-small cell lung cancer (NSCLC). This study examined the cost-effectiveness of ceritinib vs. crizotinib in the first-line treatment of ALK + NSCLC from a HK healthcare service provider's or government's perspective. Methods Costs and effectiveness of first-line ceritinib vs. crizotinib over a 20-year time horizon was evaluated using a partitioned survival model with three health states (stable disease, progressed disease, and death). The efficacy data for ceritinib were obtained from a phase 3 trial comparing ceritinib with chemotherapy for advanced non-small cell lung cancer (ASCEND-4) and extrapolated using parametric survival models. Long-term survival associated with crizotinib were estimated using hazard ratio of crizotinib vs. ceritinib obtained from matching-adjusted indirect comparison based on ASCEND-4 and PROFILE 1014 trials. Drug acquisition, administration, adverse events costs, and medical costs associated with each health state were obtained from public sources and converted to 2018 US Dollars. Incremental costs per quality-adjusted-life-year (QALY) and life-year (LY) gained were estimated for ceritinib vs. crizotinib. Results The base case results showed that ceritinib was associated with 3.22 QALYs, 4.51 LYs, and total costs of $157,581 over 20 years. Patients receiving crizotinib had 2.68 QALYs, 3.85 LYs, and $150,424 total costs over the same time horizon. The incremental cost per QALY gained for ceritinib vs crizotinib was $13,343. Results were robust to deterministic sensitivity analyses in most scenarios. Conclusion Ceritinib offers a cost-effective option compared to crizotinib for previously untreated ALK + advanced NCSLC in HK.
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Affiliation(s)
- Herbert H Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Linda K S Leung
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Andrea Chang
- Novartis Pharmaceuticals Corporation, Hong Kong, China
| | | | - Jipan Xie
- Analysis Group, Inc, Los Angeles, CA, USA
| | - Meaghan Gibbs
- Novartis Pharmaceuticals Corporation, Dubai, United Arab Emirates
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Eggleston K, Chen BK, Chen CH, Chen YI, Feenstra T, Iizuka T, Lam JTK, Leung GM, Lu JFR, Rodriguez-Sanchez B, Struijs JN, Quan J, Newhouse JP. Are quality-adjusted medical prices declining for chronic disease? Evidence from diabetes care in four health systems. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:689-702. [PMID: 32078719 DOI: 10.1007/s10198-020-01164-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Improvements in medical treatment have contributed to rising health spending. Yet there is relatively little evidence on whether the spending increase is "worth it" in the sense of producing better health outcomes of commensurate value-a critical question for understanding productivity in the health sector and, as that sector grows, for deriving an accurate quality-adjusted price index for an entire economy. We analyze individual-level panel data on medical spending and health outcomes for 123,548 patients with type 2 diabetes in four health systems: Japan, The Netherlands, Hong Kong and Taiwan. Using a "cost-of-living" method that measures value based on improved survival, we find a positive net value of diabetes care: the value of improved survival outweighs the added costs of care in each of the four health systems. This finding is robust to accounting for selective survival, end-of-life spending, and a range of values for a life-year or fraction of benefits attributable to medical care. Since the estimates do not include the value from improved quality of life, they are conservative. We, therefore, conclude that the increase in medical spending for management of diabetes is offset by an increase in quality.
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Affiliation(s)
| | | | | | | | - Talitha Feenstra
- National Institute for Public Health and Environment and University of Groningen, Groningen, The Netherlands
| | | | - Janet Tin Kei Lam
- University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong SAR, China
| | - Gabriel M Leung
- University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong SAR, China
| | | | | | - Jeroen N Struijs
- National Institute for Public Health and Environment and Leiden University Medical Center, Campus The Hague, The Hague, The Netherlands
| | - Jianchao Quan
- University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong SAR, China.
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Teoh JYC, Leung CH, Wang MH, Chiu PKF, Yee CH, Ng CF, Wong MCS. The cost-effectiveness of prostate health index for prostate cancer detection in Chinese men. Prostate Cancer Prostatic Dis 2020; 23:615-621. [PMID: 32606435 DOI: 10.1038/s41391-020-0243-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/16/2020] [Accepted: 06/17/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) and prostate health index (PHI) have been used as biomarkers for prostate cancer detection. In this study, we aimed to evaluate the cost-effectiveness of PHI for prostate cancer detection in Chinese men. METHOD We developed a Markov model for Chinese male patient aged 50-75 years old. The PSA strategy was to offer TRUS-PB for all patients with elevated PSA of 4-10 ng/mL. The PHI strategy was to offer PHI for patients with elevated PSA of 4-10 ng/mL. TRUS-PB would only be offered for patients with PHI >35.0. Model inputs were extracted from local data when available. The cost per quality-adjusted life years gained for both strategies were calculated. The incremental cost-effectiveness ratios in relation to the willingness-to-pay (WTP) threshold were compared. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Cost-effectiveness acceptability curves were also constructed. RESULTS With a Markov model of 25 screening cycles from age 50 to 75 years, the mean total costs per man were estimated to be USD 27,439 in the PSA strategy and USD 22,877 in the PHI strategy. The estimated effects were estimated to be 15.70 in the PSA strategy and 16.05 in the PHI strategy. The PHI strategy was associated with an expected decrease in cost of USD 4562 and an expected gain of 0.35 QALY, resulting in an ICER of USD -13056.56. The results were shown to be robust upon one-way sensitivity analysis. Upon Monte Carlo simulation, the PHI strategy was more cost-effective for 100% of the iterations. The PHI strategy demonstrated dominance over the PSA strategy regardless of what WTP threshold we use. CONCLUSIONS A PHI-based screening strategy may be more cost-effective than a PSA-based strategy for prostate cancer detection in Chinese men. These results support consideration of a PHI-based approach for prostate cancer in Hong Kong.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chi-Ho Leung
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Maggie Haitian Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Chi-Sang Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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13
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Hou C, Zhong X, He P, Xu B, Diao S, Yi F, Zheng H, Li J. Predicting Breast Cancer in Chinese Women Using Machine Learning Techniques: Algorithm Development. JMIR Med Inform 2020; 8:e17364. [PMID: 32510459 PMCID: PMC7308891 DOI: 10.2196/17364] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/28/2020] [Accepted: 04/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Risk-based breast cancer screening is a cost-effective intervention for controlling breast cancer in China, but the successful implementation of such intervention requires an accurate breast cancer prediction model for Chinese women. OBJECTIVE This study aimed to evaluate and compare the performance of four machine learning algorithms on predicting breast cancer among Chinese women using 10 breast cancer risk factors. METHODS A dataset consisting of 7127 breast cancer cases and 7127 matched healthy controls was used for model training and testing. We used repeated 5-fold cross-validation and calculated AUC, sensitivity, specificity, and accuracy as the measures of the model performance. RESULTS The three novel machine-learning algorithms (XGBoost, Random Forest and Deep Neural Network) all achieved significantly higher area under the receiver operating characteristic curves (AUCs), sensitivity, and accuracy than logistic regression. Among the three novel machine learning algorithms, XGBoost (AUC 0.742) outperformed deep neural network (AUC 0.728) and random forest (AUC 0.728). Main residence, number of live births, menopause status, age, and age at first birth were considered as top-ranked variables in the three novel machine learning algorithms. CONCLUSIONS The novel machine learning algorithms, especially XGBoost, can be used to develop breast cancer prediction models to help identify women at high risk for breast cancer in developing countries.
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Affiliation(s)
- Can Hou
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaorong Zhong
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Ping He
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Xu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Sha Diao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fang Yi
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hong Zheng
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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14
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Loong HH, Wong CKH, Leung LKS, Dhankhar P, Insinga RP, Chandwani S, Hsu DC, Lee MYK, Huang M, Pellissier J, Rai A, Achra M, Tan SC. Cost Effectiveness of PD-L1-Based Test-and-Treat Strategy with Pembrolizumab as the First-Line Treatment for Metastatic NSCLC in Hong Kong. PHARMACOECONOMICS - OPEN 2020; 4:235-247. [PMID: 31531842 PMCID: PMC7248157 DOI: 10.1007/s41669-019-00178-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Pembrolizumab, a monoclonal antibody against programmed death ligand 1 (PD-L1), is approved by several regulatory agencies for first-line treatment of metastatic non-small-cell lung cancer (NSCLC) with a PD-L1 tumor proportion score (TPS) ≥ 50% and no epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase genomic tumor aberrations. This study was conducted from the perspective of the Hospital Authority in Hong Kong and aimed to evaluate the cost effectiveness of a biomarker (PD-L1) test-and-treat strategy (BTS), in which patients with a TPS ≥ 50% received pembrolizumab and other patients received platinum doublet chemotherapy versus all patients receiving platinum doublet chemotherapy. METHODS The model used a partitioned survival approach to estimate the incremental cost-effectiveness ratio (ICER) expressed as the cost per quality-adjusted life-year (QALY) gained. The clinical efficacy, utility and safety data were derived from the KN024 trial. Costs and health outcomes were projected over a 10-year time horizon and discounted at 3% per year. Costs for drug acquisition, PD-L1 testing, drug administration and disease management were used. Sensitivity analyses were conducted to evaluate the robustness of results. RESULTS The BTS approach led to an increase of 0.29 QALYs at an additional cost of Hong Kong dollars (HK$) 249,077 (US$31,933) compared with platinum doublet chemotherapy, resulting in an ICER of HK$865,189 (US$110,922) per QALY gained. This is lower than the World Health Organization cost-effectiveness threshold of three times the 2016 gross domestic product (GDP) per capita for Hong Kong of HK$1017,819 (US$130,490). Probabilistic sensitivity analyses showed a 59.4% chance that the ICER would be below this threshold. CONCLUSION First-line treatment with pembrolizumab in a BTS to identify patients with NSCLC with PD-L1 TPS ≥ 50% can be considered cost effective in Hong Kong compared with platinum doublet chemotherapy based on a three-times GDP per capita threshold. However, local data on clinical efficacy and safety were not available to estimate overall survival (OS) and progression-free survival (PFS) specific to patients with NSCLC in Hong Kong. Further, uncertainty is inherent in the survival projections/extrapolation of PFS and OS beyond the trial period, and future research may help to further inform these parameters.
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Affiliation(s)
- Herbert H Loong
- Department of Clinical Oncology, State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Linda Kam Suet Leung
- Department of Clinical Oncology, State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Praveen Dhankhar
- Complete HEOR Solutions LLC, 1120 Welsh Road, Suite 205, North Wales, PA, 19454, USA
| | - Ralph P Insinga
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA.
| | - Sheenu Chandwani
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA
| | - Danny C Hsu
- Merck Sharp & Dohme (Asia) Ltd, Hong Kong, Hong Kong
| | - Mary Y K Lee
- Merck Sharp & Dohme (Asia) Ltd, Hong Kong, Hong Kong
| | - Min Huang
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA
| | - James Pellissier
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA
| | - Akanksha Rai
- Complete HEOR Solutions LLC, 1120 Welsh Road, Suite 205, North Wales, PA, 19454, USA
| | - Monika Achra
- Complete HEOR Solutions LLC, 1120 Welsh Road, Suite 205, North Wales, PA, 19454, USA
| | - Seng Chuen Tan
- Merck Sharp & Dohme (Asia Pacific), Singapore, Singapore
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15
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Yuniar P, Robinson S, Moorin R, Norman R. Economic Evaluation of Breast Cancer Early Detection Strategies in Asia: A Systematic Review. Value Health Reg Issues 2020; 21:252-263. [PMID: 32388197 DOI: 10.1016/j.vhri.2020.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/01/2019] [Accepted: 01/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This article aims to support the development of practical guidelines for early detection of breast cancer in Asia by systematically reviewing economic evaluation studies of such early detection strategies in Asian countries. METHODS A systematic literature review was conducted following the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. The quality of reviewed studies was examined using the Consolidated Health Economic Evaluation Reporting Standards statement. RESULTS A total of 15 articles on the economic evaluation of breast cancer early detection based in Asia were reviewed. Cost-effectiveness was used in all the studies as the analytic method to compare the cost and consequences of different screening policies. Ten studies were categorized as incorporating the modeled approach. Fourteen studies analysed the cost-effectiveness of the organized population-based approach, in which mammography screening was the prevailing screening modality. Only one study evaluated the cost-effectiveness of early diagnosis for breast cancer patients in order to provide early treatment. The results from the identified economic evaluations, and consequent recommendations concerning optimal early detection strategies varied among studies, and depended on key parameters and assumption used, as well as differences in inter-country health resources, breast cancer incidence, prevalence and early detection pathways. CONCLUSIONS The economic evaluation of breast cancer early detection programs is still limited in Asia. Policy decisions on organized mammography screening in women <50 are economically attractive in the region, despite the lack of evidence to provide recommendations on opportunistic screening strategy and early diagnosis strategy. Future studies need to provide better transparency of the data used and cover more comprehensive strategies, to make them relevant and adaptable to other Asian countries, resulting in clear policy recommendations on breast cancer early detection strategies.
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Affiliation(s)
- Popy Yuniar
- School of Public Health, Curtin University, Perth, Western Australia; Universitas Indonesia, West Java, Indonesia.
| | - Suzanne Robinson
- School of Public Health, Curtin University, Perth, Western Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia
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16
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Loong HH, Wong CKH, Leung LKS, Tan SC, Jen J, Lee MYK, Aguiar-Ibáñez R, Wang J. Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:2. [PMID: 31969794 PMCID: PMC6964068 DOI: 10.1186/s12962-020-0200-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pembrolizumab has been shown to improve overall survival (OS) and progression free survival (PFS) compared to ipilimumab in patients with ipilimumab-naïve advanced melanoma; however, there are no published data on the cost-effectiveness for pembrolizumab compared to standard-of-care treatments currently used in Hong Kong for advanced melanoma. Methods A partitioned-survival model based on data from a recent randomized phase 3 study (KEYNOTE-006) and meta-analysis was used to derive time in PFS, OS, and post-progression survival for pembrolizumab and chemotherapy, such as dacarbazine (DTIC), temozolomide (TMZ), and the paclitaxel-carboplatin combination (PC). A combination of clinical trial data, published data, results of meta-analysis, and melanoma registry data was used to extrapolate PFS and OS curves. The base-case time horizon for the model was 30 years with costs and health outcomes discounted at a rate of 5% per year. Individual patient level data on utilities and frequencies of adverse events were obtained from the final analysis of KEYNOTE-006 (cut-off date: 3-Dec-15) for pembrolizumab. Cost data included drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma. The distribution of patient weight from the Hong Kong population was applied to calculate the drug costs. Analyses were performed from a payer's perspective. The incremental cost effectiveness ratio (ICER) expressed as cost in US Dollars (USD) per quality-adjusted life years (QALYs) was the main outcome. Results In base-case scenario, the ICER for pembrolizumab as a first-line treatment for advanced melanoma was USD49,232 compared to DTIC, with the ICER values lower than cost-effectiveness threshold in Hong Kong. Results comparing pembrolizumab to TMZ and to PC were similar to that when compared to DTIC. Probability sensitivity analyses showed that 99% of the simulated ICERs were below three times the Gross Domestic Product (GDP) per capita for Hong Kong (currently at $119,274//QALY threshold). In a scenario analysis comparing pembrolizumab with ipilimumab, the estimated ICER was USD8,904. Conclusions Pembrolizumab is cost-effective relative to chemotherapy (DTIC, TMZ and PC), and highly-cost-effective compared to ipilimumab, for the first-line treatment of advanced melanoma in Hong Kong.
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Affiliation(s)
- Herbert H Loong
- 1Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.,State Key Laboratory in Translational Research, Hong Kong Cancer Institute, Hong Kong, Hong Kong SAR, China
| | - Carlos K H Wong
- 3Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Linda K S Leung
- 1Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.,State Key Laboratory in Translational Research, Hong Kong Cancer Institute, Hong Kong, Hong Kong SAR, China
| | - S C Tan
- MSD Asia Pacific, Singapore, Singapore
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17
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Huang Y, Tong Z, Chen K, Wang Y, Liu P, Gu L, Liu J, Yu J, Song F, Zhao W, Shi Y, Li H, Xiao H, Hao X. Interpretation of breast cancer screening guideline for Chinese women. Cancer Biol Med 2019; 16:825-835. [PMID: 31908899 PMCID: PMC6936244 DOI: 10.20892/j.issn.2095-3941.2019.0322] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/26/2019] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignant tumor in Chinese women. Early screening is the best way to improve the rates of early diagnosis and survival of breast cancer patients. The peak onset age for breast cancer in Chinese women is considerably younger than those in European and American women. It is imperative to develop breast cancer screening guideline that is suitable for Chinese women. By summarizing the current evidence on breast cancer screening in Chinese women, and referring to the latest guidelines and consensus on breast cancer screening in Europe, the United States, and East Asia, the China Anti-Cancer Association and National Clinical Research Center for Cancer (Tianjin Medical University Cancer Institute and Hospital) have formulated population-based guideline for breast cancer screening in Chinese women. The guideline provides recommendations on breast cancer screening for Chinese women at average or high risk of breast cancer according to the following three aspects: age of screening, screening methods, and screening interval. This article provides more detailed information to support the recommendations in this guideline and to provide more direction for current breast cancer screening practices in China.
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Affiliation(s)
| | | | - Kexin Chen
- Department of Epidemiology and Statistics
| | - Ying Wang
- Department of Epidemiology and Statistics
- China Anti-Cancer Association, Tianjin 300060, China
| | | | - Lin Gu
- The 2 Surgery Department of Breast Oncology
| | | | - Jinpu Yu
- Cancer Molecular Diagnostics Core
| | | | - Wenhua Zhao
- Department of Epidemiology and Statistics
- China Anti-Cancer Association, Tianjin 300060, China
| | - Yehui Shi
- Medicine Department of Breast Oncology
| | - Hui Li
- Department of Gastrointestinal Cancer Biology
| | - Huaiyuan Xiao
- Department of Research and Education, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xishan Hao
- Department of Epidemiology and Statistics
- China Anti-Cancer Association, Tianjin 300060, China
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18
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The Structure and Parameterization of the Breast Cancer Transition Model Among Chinese Women. Value Health Reg Issues 2019; 21:29-38. [PMID: 31634794 DOI: 10.1016/j.vhri.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Markov model simulation based on the natural history of disease is commonly employed for the comparative research of health interventions. The present study aims to simulate the natural progression of breast cancer and parameterize the initial and transition probabilities of multiple states of breast cancer development among Chinese women. METHODS The age-specific incidence, mortality, and clinical stage distribution of breast cancer; and relapse rate of each clinical stage were collected from China's cancer registry yearbooks and clinical epidemiological studies to simulate the process from full health to breast cancer to death among Chinese women aged 30 to 80 through a Markov cohort study. The validity analysis was conducted to evaluate the accuracy of the model estimation. RESULTS A Markov transition model with 7 states (no breast cancer, clinical stages 0-IV breast cancer, and death) was constructed for Chinese women. The age-specific incidence, mortality, and clinical stage distribution of breast cancer estimated by the initial and transition probabilities among different Markov states were highly consistent with the registered data and observed studies. CONCLUSION A breast cancer transition model for Chinese women has been established with validity. It could be a point of reference for further economic evaluations and breast cancer screening policy formulation.
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19
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Salikhanov I, Crape B, Howie P. Cost- Effectiveness of Mammography Screening Program in a Resource-Limited Post-Soviet Country of Kazakhstan. Asian Pac J Cancer Prev 2019; 20:3153-3160. [PMID: 31653167 PMCID: PMC6982668 DOI: 10.31557/apjcp.2019.20.10.3153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To conduct cost effectiveness and benefit-cost analyses of the organized mammography-screening program in the Republic of Kazakhstan comparing women who developed breast cancer in screened and unscreened scenario. METHODS 389,352 screened women were included in the study. Among these, 895 women were further diagnosed with breast cancer. Outcomes measures include life years saved, quality-adjusted life years, incremental cost-effectiveness ratio, and value of statistical life year. Sensitivity analyses were performed to assess uncertainty. RESULTS Compared to no screening scenario, an organized mammography yielded an additional 1,253 life years and 790 quality-adjusted life years in 2016. The incremental cost-effectiveness ratio was equal to 3,157 USD per one QALY saved, which is two times less than the GDP per capita in Kazakhstan in 2016. Sensitivity analysis showed that the mammography remains cost-effective in the majority of the scenarios. CONCLUSION Mammography screening in Kazakhstan was found to be highly cost-effective, associated with treatment cost savings, and can be an efficient use of limited resources in Kazakhstan.
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Affiliation(s)
- Islam Salikhanov
- Nazarbayev University, School of Medicine, Nur-Sultan, Kazakhstan.
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20
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Sun L, Sadique Z, Dos-Santos-Silva I, Yang L, Legood R. Cost-effectiveness of breast cancer screening programme for women in rural China. Int J Cancer 2018; 144:2596-2604. [PMID: 30367451 DOI: 10.1002/ijc.31956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/05/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Abstract
In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35-64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost-effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality-adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.
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Affiliation(s)
- Li Sun
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,School of Public Health, Peking University, Beijing, China
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Isabel Dos-Santos-Silva
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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21
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Sun L, Legood R, Sadique Z, dos-Santos-Silva I, Yang L. Cost-effectiveness of risk-based breast cancer screening programme, China. Bull World Health Organ 2018; 96:568-577. [PMID: 30104797 PMCID: PMC6083393 DOI: 10.2471/blt.18.207944] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To model the cost-effectiveness of a risk-based breast cancer screening programme in urban China, launched in 2012, compared with no screening. METHODS We developed a Markov model to estimate the lifetime costs and effects, in terms of quality-adjusted life years (QALYs), of a breast cancer screening programme for high-risk women aged 40-69 years. We derived or adopted age-specific incidence and transition probability data, assuming a natural history progression between the stages of cancer, from other studies. We obtained lifetime direct and indirect treatment costs in 2014 United States dollars (US$) from surveys of breast cancer patients in 37 Chinese hospitals. To calculate QALYs, we derived utility scores from cross-sectional patient surveys. We evaluated incremental cost-effectiveness ratios for various scenarios for comparison with a willingness-to-pay threshold. FINDINGS Our baseline model of annual screening yielded an incremental cost-effectiveness ratio of US$ 8253/QALY, lower than the willingness-to-pay threshold of US$ 23 050/QALY. One-way and probabilistic sensitivity analyses demonstrated that the results are robust. In the exploration of various scenarios, screening every 3 years is the most cost-effective with an incremental cost-effectiveness ratio of US$ 6671/QALY. The cost-effectiveness of the screening is reduced if not all diagnosed women seek treatment. Finally, the economic benefit of screening women aged 45-69 years with both ultrasound and mammography, compared with mammography alone, is uncertain. CONCLUSION High-risk population-based breast cancer screening is cost-effective compared with no screening.
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Affiliation(s)
- Li Sun
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Isabel dos-Santos-Silva
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Li Yang
- School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100191, China
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22
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Poorolajal J, Akbari ME, Ziaee F, Karami M, Ghoncheh M. Breast cancer screening (BCS) chart: a basic and preliminary model for making screening mammography more productive and efficient. J Public Health (Oxf) 2018; 40:e118-e125. [PMID: 28505346 DOI: 10.1093/pubmed/fdx052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The breast cancer screening (BCS) chart is suggested as a basic and preliminary tool to improve efficiency of screening mammography. METHODS We conducted this case-control study in 2016 and enrolled 1422 women aged 30-75 years, including 506 women with breast cancer (cases) and 916 women without breast cancer (controls). We developed the BCS chart using a multiple logistic regression analysis. We combined the risks of breast cancer to predict the individual risk of breast cancer. Then, we stratified and colored the predicted risk probabilities as follows: <05% (green), 05-09% (yellow), 10-14% (orange), 15-19% (red), 20-24% (brown) and ≥25% (black). RESULTS The BCS chart provides the risk probability of breast cancer, based on age, body mass index, late menopause, having a benign breast disease and a positive family history of breast cancer among the first-degree or the second/third-degree relatives. According to this chart, an individual can be classified in a category of low risk (green), medium risk (yellow and orange), high risk (red and brown) and very high risk (black) for breast cancer. CONCLUSIONS This chart is a flexible and easy to use tool that can detect high-risk subjects and make the screening program more efficient and productive.
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Affiliation(s)
- Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Fatane Ziaee
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manoochehr Karami
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Ghoncheh
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nguyen CP, Adang EMM. Cost-effectiveness of breast cancer screening using mammography in Vietnamese women. PLoS One 2018; 13:e0194996. [PMID: 29579131 PMCID: PMC5868837 DOI: 10.1371/journal.pone.0194996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background The incidence rate of breast cancer is increasing and has become the most common cancer in Vietnamese women while the survival rate is lower than that of developed countries. Early detection to improve breast cancer survival as well as reducing risk factors remains the cornerstone of breast cancer control according to the World Health Organization (WHO). This study aims to evaluate the costs and outcomes of introducing a mammography screening program for Vietnamese women aged 45–64 years, compared to the current situation of no screening. Methods Decision analytical modeling using Markov chain analysis was used to estimate costs and health outcomes over a lifetime horizon. Model inputs were derived from published literature and the results were reported as incremental cost-effectiveness ratios (ICERs) and/or incremental net monetary benefits (INMBs). One-way sensitivity analyses and probabilistic sensitivity analyses were performed to assess parameter uncertainty. Results The ICER per life year gained of the first round of mammography screening was US$3647.06 and US$4405.44 for women aged 50–54 years and 55–59 years, respectively. In probabilistic sensitivity analyses, mammography screening in the 50–54 age group and the 55–59 age group were cost-effective in 100% of cases at a threshold of three times the Vietnamese Gross Domestic Product (GDP) i.e., US$6332.70. However, less than 50% of the cases in the 60–64 age group and 0% of the cases in the 45–49 age group were cost effective at the WHO threshold. The ICERs were sensitive to the discount rate, mammography sensitivity, and transition probability from remission to distant recurrence in stage II for all age groups. Conclusion From the healthcare payer viewpoint, offering the first round of mammography screening to Vietnamese women aged 50–59 years should be considered, with the given threshold of three times the Vietnamese GDP per capita.
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Affiliation(s)
- Chi Phuong Nguyen
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam
- * E-mail:
| | - Eddy M. M. Adang
- Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Yang L, Wang J, Cheng J, Wang Y, Lu W. Quality assurance target for community-based breast cancer screening in China: a model simulation. BMC Cancer 2018. [PMID: 29514679 PMCID: PMC5840933 DOI: 10.1186/s12885-018-4168-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control. Methods A state-transition Markov model simulated a hypothetical cohort of 100,000 healthy women, the start aged was set at 35 years and the time horizon was set to 50 years. The primary outcome for the model was the incremental cost-utility ratio (ICUR), defined as the program’s cost per quality-adjusted life year (QALY) gained. Three screening strategies providing by community health service for women aged 35 to 69 years was compared regarding to different intervals. Result The probability of the ICUR being below 20 272USD (i.e., triple the annual gross domestic product [3 GDPs]) per QALY saved was 100% for annual screening strategy and screening every three years. Only when the attendance rate was > 50%, the probability for annual screening would be cost effective > 95%. The probability for the annual screening strategy being cost effective could reach to 95% for a willingness-to-pay (WTP) of 2 GDPs when the compliance rate for transfer was > 80%. When 10% stage I tumors were detected by screening, the probability of the annual screening strategy being cost effective would be up to 95% for a WTP > 3 GDPs. Conclusion Annual community-based breast cancer screening was cost effective for a WTP of 3 GDP based on the incidence of breast cancer in Tianjin, China. Measures are needed to ensure performance indicators to a desirable level for the cost-effectiveness of breast cancer screening. Electronic supplementary material The online version of this article (10.1186/s12885-018-4168-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.,Tianjin Binhai New Area Tanggu Center for Disease Control and Prevention, Tianjin, 300451, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Juan Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.,Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical University, Tianjin, 300070, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China. .,Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical University, Tianjin, 300070, China.
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25
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Schiller-Frühwirth IC, Jahn B, Arvandi M, Siebert U. Cost-Effectiveness Models in Breast Cancer Screening in the General Population: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:333-351. [PMID: 28185134 DOI: 10.1007/s40258-017-0312-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many Western countries have long-established population-based mammography screening programs. Prior to implementing these programs, decision-analytic modeling was widely used to inform decisions. OBJECTIVE The aim of this study was to perform a systematic review of cost-effectiveness models in breast cancer screening in the general population to analyze their structural and methodological approaches. METHODS A systematic literature search for health economic models was performed in the electronic databases MEDLINE (Ovid), EMBASE, CRD Databases, Cochrane Library, and EconLit in August 2011 with updates in June 2013, April 2015, and November 2016. To assess studies systematically, a standardized form was applied to extract relevant information that was then summarized in evidence tables. RESULTS Thirty-five studies were included; 27 state-transition models were analyzed using cohort (n = 12) and individual-level simulation (n = 15). Twenty-one studies modeled the natural history of breast cancer and predicted mortality as a function of the early detection modality. The models employed different assumptions regarding ductal carcinoma in situ. Thirteen studies performed cost-utility analyses with different sources for utility values, but assumptions were often made about utility weights. Twenty-two models did not report any validation. CONCLUSION State-transition modeling was the most frequently applied analytic approach. Different methods in modeling the progression of ductal carcinoma in situ to invasive cancer were identified because there is currently no agreement on the biological behavior of noninvasive breast cancer. Main weaknesses were the lack of precise utility estimates and insufficient reporting of validation. Sensitivity analyses of assumptions regarding ductal carcinoma in situ and in particular adequate validation are critical to minimize the risk of biased model outcomes.
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Affiliation(s)
- Irmgard C Schiller-Frühwirth
- Department of Evidence-Based Economic Health Care, Main Association of Austrian Social Security Institutions, Kundmanngasse 21, 1030, Vienna, Austria.
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Marjan Arvandi
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Zhao Y, Xiong P, McCullough LE, Miller EE, Li H, Huang Y, Zhao M, Wang MJ, Kang M, Wang Q, Li JY. Comparison of Breast Cancer Risk Predictive Models and Screening Strategies for Chinese Women. J Womens Health (Larchmt) 2017; 26:294-302. [PMID: 28263689 DOI: 10.1089/jwh.2015.5692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ying Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
- Department of Discipline Construction, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ping Xiong
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Lauren E. McCullough
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Erline E. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Hui Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Yuan Huang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Min Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Meng-jie Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Min Kang
- The Comprehensive Guidance Center of Women's Health, Women's and Children's Hospital of Sichuan Province, Chengdu, People's Republic of China
| | - Qiong Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jia-yuan Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
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Lee M, Mariapun S, Rajaram N, Teo SH, Yip CH. Performance of a subsidised mammographic screening programme in Malaysia, a middle-income Asian country. BMC Public Health 2017; 17:127. [PMID: 28129762 PMCID: PMC5273834 DOI: 10.1186/s12889-017-4015-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of breast cancer in Asia is increasing because of urbanization and lifestyle changes. In the developing countries in Asia, women present at late stages, and mortality is high. Mammographic screening is the only evidence-based screening modality that reduces breast cancer mortality. To date, only opportunistic screening is offered in the majority of Asian countries because of the lack of justification and funding. Nevertheless, there have been few reports on the effectiveness of such programmes. In this study, we describe the cancer detection rate and challenges experienced in an opportunistic mammographic screening programme in Malaysia. METHODS From October 2011 to June 2015, 1,778 asymptomatic women, aged 40-74 years, underwent subsidised mammographic screening. All patients had a clinical breast examination before mammographic screening, and women with mammographic abnormalities were referred to a surgeon. The cancer detection rate and variables associated with a recommendation for adjunct ultrasonography were determined. RESULTS The mean age for screening was 50.8 years and seven cancers (0.39%) were detected. The detection rate was 0.64% in women aged 50 years and above, and 0.12% in women below 50 years old. Adjunct ultrasonography was recommended in 30.7% of women, and was significantly associated with age, menopausal status, mammographic density and radiologist's experience. The main reasons cited for recommendation of an adjunct ultrasound was dense breasts and mammographic abnormalities. DISCUSSION The cancer detection rate is similar to population-based screening mammography programmes in high-income Asian countries. Unlike population-based screening programmes in Caucasian populations where the adjunct ultrasonography rate is 2-4%, we report that 3 out of 10 women attending screening mammography were recommended for adjunct ultrasonography. This could be because Asian women attending screening are likely premenopausal and hence have denser breasts. Radiologists who reported more than 360 mammograms were more confident in reporting a mammogram as normal without adjunct ultrasonography compared to those who reported less than 180 mammograms. CONCLUSION Our subsidised opportunistic mammographic screening programme is able to provide equivalent cancer detection rates but the high recall for adjunct ultrasonography would make screening less cost-effective.
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Affiliation(s)
| | | | | | - Soo-Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Malaysia.,University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia. .,Subang Jaya Medical Centre, No 1, Jalan SS12/1A, 47500, Subang Jaya, Malaysia.
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Demchig D, Mello-Thoms C, Brennan PC. Breast cancer in Mongolia: an increasingly important health policy issue. BREAST CANCER-TARGETS AND THERAPY 2017; 9:29-38. [PMID: 28176935 PMCID: PMC5268367 DOI: 10.2147/bctt.s125584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Breast cancer is a leading cause of cancer-related death for women in both developed and developing countries. The incidence and mortality of breast cancer in Mongolia, while low compared with other counties, has been increasing on an annual basis. In addition, in Mongolia, approximately 90% of the patients are diagnosed at a late stage, resulting in high mortality, with the majority of individuals diagnosed with breast cancer dying within 5 years of diagnosis. Breast cancer screening plays an important role in reducing mortality in Western countries and has been adopted by a number of Asian countries; however, no such approach exists in Mongolia. In a country of limited resources, implementation of expensive health strategies such as screening requires effective allocations of resources and the identification of the most effective imaging methods. This requirement relies on recent accurate data; however, at this time, there is a paucity of information around breast cancer in Mongolia. Until data around features of the disease are available, effective strategies to diagnose breast cancer that recognize the economic climate in Mongolia cannot be implemented and the impact of breast cancer is likely to increase.
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Affiliation(s)
- Delgermaa Demchig
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Health Science, The University of Sydney, Sydney, NSW, Australia
| | - Claudia Mello-Thoms
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Health Science, The University of Sydney, Sydney, NSW, Australia
| | - Patrick C Brennan
- Medical Image Optimization and Perception Group (MIOPeG), Faculty of Health Science, The University of Sydney, Sydney, NSW, Australia
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Christensen MK, Niclasen BV, Iburg KM. Societal costs and effects of implementing population-based mammography screening in Greenland. Int J Circumpolar Health 2017; 76:1373580. [PMID: 28934900 PMCID: PMC5645766 DOI: 10.1080/22423982.2017.1373580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/25/2017] [Indexed: 11/30/2022] Open
Abstract
With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper is to evaluate the cost effectiveness and cost utility of different strategies for implementing population-based breast cancer screening in Greenland. Two strategies were evaluated: Centralised screening in the capital Nuuk and decentralised screening in the five municipal regions of Greenland. A cost effectiveness and cost utility analysis were performed from a societal perspective to estimate the costs per years of life saved and per QALY gained. Two accommodation models for the women's attendance were examined; accommodation in ordinary hotels or in patient hotels. The least costly accommodation model was the hotel model compared with the patient hotel model, regardless of screening strategy. The decentralised strategy was more cost effective compared with the centralised strategy, resulting in 0.5 million DKK per years of life saved (YLS) and 4.1 million DKK per quality-adjusted life year (QALY) gained within the hotel model. These ratios are significantly higher compared with findings from other countries. The sensitivity analysis showed a substantial gap between the most and least favourable model assumptions. The investigated strategies were all estimated to be extremely costly, mostly due to high transportation and accommodation costs and loss of productivity, and none would be accepted as cost-effective per YLS/QALY gained within a conventional threshold level. The least expensive strategy was regional screening with hotel accommodation.
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30
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Wong CKH, Lang BHH, Guo VYW, Lam CLK. Possible Impact of Incremental Cost-Effectiveness Ratio (ICER) on Decision Making for Cancer Screening in Hong Kong: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:647-657. [PMID: 27502943 DOI: 10.1007/s40258-016-0266-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this paper was to critically review the literature on the cost effectiveness of cancer screening interventions, and examine the incremental cost-effectiveness ratios (ICERs) that may influence government recommendations on cancer screening strategies and funding for mass implementation in the Hong Kong healthcare system. METHODS We conducted a literature review of cost-effectiveness studies in the Hong Kong population related to cancer screening published up to 2015, through a hand search and database search of PubMed, Web of Science, Embase, and OVID Medline. Binary data on the government's decisions were obtained from the Cancer Expert Working Group, Department of Health. Mixed-effect logistic regression analysis was used to examine the impact of ICERs on decision making. Using Youden's index, an optimal ICER threshold value for positive decisions was examined by area under receiver operating characteristic curve (AUC). RESULTS Eight studies reporting 30 cost-effectiveness pairwise comparisons of population-based cancer screening were identified. Most studies reported an ICER for a cancer screening strategy versus a comparator with outcomes in terms of cost per life-years (55.6 %), or cost per quality-adjusted life-years (55.6 %). Among comparisons with a mean ICER of US$102,931 (range 800-715,137), the increase in ICER value by 1000 was associated with decreased odds (odds ratio 0.990, 0.981-0.999; p = 0.033) of a positive recommendation. An optimal ICER value of US$61,600 per effectiveness unit yielded a high sensitivity of 90 % and specificity of 85 % for a positive recommendation. A lower ICER threshold value of below US$8044 per effectiveness unit was detected for a positive funding decision. CONCLUSIONS Linking published evidence to Government recommendations and practice on cancer screening, ICERs influence decisions on the adoption of health technologies in Hong Kong. The potential ICER threshold for recommendation in Hong Kong may be higher than those of developed countries.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong.
| | - Brian H H Lang
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Vivian Y W Guo
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
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Evans DG, Astley S, Stavrinos P, Harkness E, Donnelly LS, Dawe S, Jacob I, Harvie M, Cuzick J, Brentnall A, Wilson M, Harrison F, Payne K, Howell A. Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04110] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BackgroundIn the UK, women are invited for 3-yearly mammography screening, through the NHS Breast Screening Programme (NHSBSP), from the ages of 47–50 years to the ages of 69–73 years. Women with family histories of breast cancer can, from the age of 40 years, obtain enhanced surveillance and, in exceptionally high-risk cases, magnetic resonance imaging. However, no NHSBSP risk assessment is undertaken. Risk prediction models are able to categorise women by risk using known risk factors, although accurate individual risk prediction remains elusive. The identification of mammographic breast density (MD) and common genetic risk variants [single nucleotide polymorphisms (SNPs)] has presaged the improved precision of risk models.ObjectivesTo (1) identify the best performing model to assess breast cancer risk in family history clinic (FHC) and population settings; (2) use information from MD/SNPs to improve risk prediction; (3) assess the acceptability and feasibility of offering risk assessment in the NHSBSP; and (4) identify the incremental costs and benefits of risk stratified screening in a preliminary cost-effectiveness analysis.DesignTwo cohort studies assessing breast cancer incidence.SettingHigh-risk FHC and the NHSBSP Greater Manchester, UK.ParticipantsA total of 10,000 women aged 20–79 years [Family History Risk Study (FH-Risk); UK Clinical Research Network identification number (UKCRN-ID) 8611] and 53,000 women from the NHSBSP [aged 46–73 years; Predicting the Risk of Cancer At Screening (PROCAS) study; UKCRN-ID 8080].InterventionsQuestionnaires collected standard risk information, and mammograms were assessed for breast density by a number of techniques. All FH-Risk and 10,000 PROCAS participants participated in deoxyribonucleic acid (DNA) studies. The risk prediction models Manual method, Tyrer–Cuzick (TC), BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) and Gail were used to assess risk, with modelling based on MD and SNPs. A preliminary model-based cost-effectiveness analysis of risk stratified screening was conducted.Main outcome measuresBreast cancer incidence.Data sourcesThe NHSBSP; cancer registration.ResultsA total of 446 women developed incident breast cancers in FH-Risk in 97,958 years of follow-up. All risk models accurately stratified women into risk categories. TC had better risk precision than Gail, and BOADICEA accurately predicted risk in the 6268 single probands. The Manual model was also accurate in the whole cohort. In PROCAS, TC had better risk precision than Gail [area under the curve (AUC) 0.58 vs. 0.54], identifying 547 prospective breast cancers. The addition of SNPs in the FH-Risk case–control study improved risk precision but was not useful inBRCA1(breast cancer 1 gene) families. Risk modelling of SNPs in PROCAS showed an incremental improvement from using SNP18 used in PROCAS to SNP67. MD measured by visual assessment score provided better risk stratification than automatic measures, despite wide intra- and inter-reader variability. Using a MD-adjusted TC model in PROCAS improved risk stratification (AUC = 0.6) and identified significantly higher rates (4.7 per 10,000 vs. 1.3 per 10,000;p < 0.001) of high-stage cancers in women with above-average breast cancer risks. It is not possible to provide estimates of the incremental costs and benefits of risk stratified screening because of lack of data inputs for key parameters in the model-based cost-effectiveness analysis.ConclusionsRisk precision can be improved by using DNA and MD, and can potentially be used to stratify NHSBSP screening. It may also identify those at greater risk of high-stage cancers for enhanced screening. The cost-effectiveness of risk stratified screening is currently associated with extensive uncertainty. Additional research is needed to identify data needed for key inputs into model-based cost-effectiveness analyses to identify the impact on health-care resource use and patient benefits.Future workA pilot of real-time NHSBSP risk prediction to identify women for chemoprevention and enhanced screening is required.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. The DNA saliva collection for SNP analysis for PROCAS was funded by the Genesis Breast Cancer Prevention Appeal.
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Affiliation(s)
- D Gareth Evans
- Department of Genomic Medicine, Institute of Human Development, Manchester Academic Health Science Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Susan Astley
- Institute of Population Health, Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Paula Stavrinos
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Elaine Harkness
- Institute of Population Health, Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Louise S Donnelly
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Sarah Dawe
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Ian Jacob
- Department of Health Economics, University of Manchester, Manchester, UK
| | - Michelle Harvie
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Adam Brentnall
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Mary Wilson
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
| | | | - Katherine Payne
- Department of Health Economics, University of Manchester, Manchester, UK
| | - Anthony Howell
- Institute of Population Health, Centre for Imaging Sciences, University of Manchester, Manchester, UK
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Manchester, UK
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Rafia R, Brennan A, Madan J, Collins K, Reed MWR, Lawrence G, Robinson T, Greenberg D, Wyld L. Modeling the Cost-Effectiveness of Alternative Upper Age Limits for Breast Cancer Screening in England and Wales. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:404-12. [PMID: 27325332 DOI: 10.1016/j.jval.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND Currently in the United Kingdom, the National Health Service (NHS) Breast Screening Programme invites all women for triennial mammography between the ages of 47 and 73 years (the extension to 47-50 and 70-73 years is currently examined as part of a randomized controlled trial). The benefits and harms of screening in women 70 years and older, however, are less well documented. OBJECTIVES The aim of this study was to examine whether extending screening to women older than 70 years would represent a cost-effective use of NHS resources and to identify the upper age limit at which screening mammography should be extended in England and Wales. METHODS A mathematical model that allows the impact of screening policies on cancer diagnosis and subsequent management to be assessed was built. The model has two parts: a natural history model of the progression of breast cancer up to discovery and a postdiagnosis model of treatment, recurrence, and survival. The natural history model was calibrated to available data and compared against published literature. The management of breast cancer at diagnosis was taken from registry data and valued using official UK tariffs. RESULTS The model estimated that screening would lead to overdiagnosis in 6.2% of screen-detected women at the age of 72 years, increasing up to 37.9% at the age of 90 years. Under commonly quoted willingness-to-pay thresholds in the United Kingdom, our study suggests that an extension to screening up to the age of 78 years represents a cost-effective strategy. CONCLUSIONS This study provides encouraging findings to support the extension of the screening program to older ages and suggests that further extension of the UK NHS Breast Screening Programme up to age 78 years beyond the current upper age limit of 73 years could be potentially cost-effective according to current NHS willingness-to-pay thresholds.
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Affiliation(s)
- Rachid Rafia
- School of Health and Related Research, Health Economics and Decision Science, University of Sheffield, Sheffield, UK.
| | - Alan Brennan
- School of Health and Related Research, Health Economics and Decision Science, University of Sheffield, Sheffield, UK
| | - Jason Madan
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Karen Collins
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Malcolm W R Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Gill Lawrence
- Breast Screening QA Reference Centre, West Midlands Cancer Intelligence Unit, Public Health Building, The University of Birmingham, Birmingham, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - David Greenberg
- Eastern Cancer Registration and Information Centre (ECRIC), Unit C, Cambridge, UK
| | - Lynda Wyld
- Academic Unit of Surgical Oncology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
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Haghighat S, Akbari ME, Yavari P, Javanbakht M, Ghaffari S. Cost-Effectiveness of Three Rounds of Mammography Breast Cancer Screening in Iranian Women. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e5443. [PMID: 27366315 PMCID: PMC4922208 DOI: 10.17795/ijcp-5443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in Iranian women as is worldwide. Mammography screening has been introduced as a beneficial method for reducing mortality and morbidity of this disease. OBJECTIVES We developed an analytical model to assess the cost effectiveness of an organized mammography screening program in Iran for early detection of the breast cancer. PATIENTS AND METHODS This study is an economic evaluation of mammography screening program among Iranian woman aged 40 - 70 years. A decision tree and Markov model were applied to estimate total quality adjusted life years (QALY) and lifetime costs. RESULTS The results revealed that the incremental cost effectiveness ratio (ICER) of mammography screening in Iranian women in the first round was Int. $ 37,350 per QALY gained. The model showed that the ICER in the second and third rounds of screening program were Int. $ 141,641 and Int. $ 389,148 respectively. CONCLUSIONS Study results identified that mammography screening program was cost-effective in 53% of the cases, but incremental cost per QALY in the second and third rounds of screening are much higher than the accepted payment threshold of Iranian health system. Thus, evaluation of other screening strategies would be useful to identify more cost-effective program. Future studies with new national data can improve the accuracy of our finding and provide better information for health policy makers for decision making.
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Affiliation(s)
- Shahpar Haghighat
- Breast Cancer Research Center (BCRC), ACECR, Tehran, IR Iran
- Epidemiology Department, School of Public Health, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, IR Iran
| | - Mohammad Esmaeil Akbari
- Cancer Research Center (CRC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, IR Iran
| | - Parvin Yavari
- Epidemiology Department, School of Public Health, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, IR Iran
- Department of Health and Community Medicine, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, IR Iran
| | - Mehdi Javanbakht
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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van Ravesteyn NT, Stout NK, Schechter CB, Heijnsdijk EAM, Alagoz O, Trentham-Dietz A, Mandelblatt JS, de Koning HJ. Benefits and harms of mammography screening after age 74 years: model estimates of overdiagnosis. J Natl Cancer Inst 2015; 107:djv103. [PMID: 25948872 DOI: 10.1093/jnci/djv103] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 03/17/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to quantify the benefits and harms of mammography screening after age 74 years, focusing on the amount of overdiagnosis of invasive breast cancer and ductal carcinoma in situ (DCIS). METHODS Three well-established microsimulation models were used to simulate a cohort of American women born in 1960. All women received biennial screening starting at age 50 years with cessation ages varying from 74 up to 96 years. We estimated the number of life-years gained (LYG), quality-adjusted life-years, breast cancer deaths averted, false-positives, and overdiagnosed women per 1000 screens. RESULTS The models predicted that there were 7.8 to 11.4 LYG per 1000 screens at age 74 years (range across models), decreasing to 4.8 to 7.8 LYG per 1000 screens at age 80 years, and 1.4 to 2.4 LYG per 1000 screens at age 90 years. When adjusted for quality-of-life decrements, the LYG decreased by 5% to 13% at age 74 years and 11% to 22% at age 80 years. At age 90 to 92 years, all LYG were counterbalanced by a loss in quality-of-life, mainly because of the increasing number of overdiagnosed breast cancers per 1000 screens: 1.2 to 5.0 at age 74 years, 1.8 to 6.0 at age 80 years, and 3.7 to 7.5 at age 90 years. The age at which harms began to outweigh benefits shifted to a younger age when larger or longer utility losses because of a breast cancer diagnosis were assumed. CONCLUSION The balance between screening benefits and harms becomes less favorable after age 74 years. At age 90 years, harms outweigh benefits, largely as a consequence of overdiagnosis. This age was the same across the three models, despite important model differences in assumptions on DCIS.
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Affiliation(s)
- Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM).
| | - Natasha K Stout
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
| | - Clyde B Schechter
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
| | - Oguzhan Alagoz
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
| | - Amy Trentham-Dietz
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
| | - Jeanne S Mandelblatt
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (NTvR, EAMH, HJdK); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Department of Industrial and Systems Engineering (OA) and Carbone Cancer Center and Department of Population Health Sciences (ATD), University of Wisconsin-Madison, Madison, WI; Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM)
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Zhang R, Modaresi F, Borisenko O. Health economic evaluations of medical devices in the People's Republic of China: A systematic literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:195-204. [PMID: 25914551 PMCID: PMC4399785 DOI: 10.2147/ceor.s78752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The objective of this study is to identify and review the methodological quality of health economic evaluations of medical devices performed in the People’s Republic of China. To our knowledge, no such investigations have been performed to date. Methods A systematic literature review involving searches of Medline, Medline In-Process, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry of the Tufts Medical Center, and the Wanfang Database was performed. The search spanned the period from 1990 to 2013. Studies on health economic evaluations of medical devices, in-vitro diagnostics, procedures, and the use of medical devices in Chinese health care settings were included. Full-text articles and conference abstracts in English and Chinese were included. Results Fifty-seven publications were included, 26 (46%) of which were in English and 31 (54%) of which were in Chinese. The included publications covered a wide range of clinical areas, such as surgery (n=23, 40%), screening (n=9, 16%), imaging use (n=6, 11%), kidney intervention (n=4, 7%), and nine other technological areas. Most of the studies (n=31, 54%) were cost analyses. Among the others, 13 (50%) studies used modeling, and another 13 (50%) were within-trial evaluations. Among studies that used modeling, eleven (85%) conducted sensitivity analyses, six of which had one-way sensitivity analysis, whereas one conducted both one-way and two-way sensitivity analyses; four of these eleven modeling-based analyses included probabilistic sensitivity analyses. The incremental cost-effectiveness ratio was reported in ten (18%) studies, eight of which were screening studies. The remaining two modeling studies were in areas of imaging and oncology. Conclusion This study indicates that there are major limitations and deficiencies in the health economic evaluations on medical devices performed in the People’s Republic of China. Further efforts are required from different stakeholders – academic, governmental, and privatized – to improve health economic research capacity and to put it to use when informative decisions are made in the health care setting.
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Koleva-Kolarova RG, Zhan Z, Greuter MJW, Feenstra TL, De Bock GH. Simulation models in population breast cancer screening: A systematic review. Breast 2015; 24:354-63. [PMID: 25906671 DOI: 10.1016/j.breast.2015.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 11/15/2022] Open
Abstract
The aim of this review was to critically evaluate published simulation models for breast cancer screening of the general population and provide a direction for future modeling. A systematic literature search was performed to identify simulation models with more than one application. A framework for qualitative assessment which incorporated model type; input parameters; modeling approach, transparency of input data sources/assumptions, sensitivity analyses and risk of bias; validation, and outcomes was developed. Predicted mortality reduction (MR) and cost-effectiveness (CE) were compared to estimates from meta-analyses of randomized control trials (RCTs) and acceptability thresholds. Seven original simulation models were distinguished, all sharing common input parameters. The modeling approach was based on tumor progression (except one model) with internal and cross validation of the resulting models, but without any external validation. Differences in lead times for invasive or non-invasive tumors, and the option for cancers not to progress were not explicitly modeled. The models tended to overestimate the MR (11-24%) due to screening as compared to optimal RCTs 10% (95% CI - 2-21%) MR. Only recently, potential harms due to regular breast cancer screening were reported. Most scenarios resulted in acceptable cost-effectiveness estimates given current thresholds. The selected models have been repeatedly applied in various settings to inform decision making and the critical analysis revealed high risk of bias in their outcomes. Given the importance of the models, there is a need for externally validated models which use systematical evidence for input data to allow for more critical evaluation of breast cancer screening.
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Affiliation(s)
- Rositsa G Koleva-Kolarova
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Zhuozhao Zhan
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Marcel J W Greuter
- University of Groningen, University Medical Center Groningen, Department of Radiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Talitha L Feenstra
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands; RIVM, PO Box 1, 3720BA Bilthoven, The Netherlands.
| | - Geertruida H De Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
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Ribeiro RA, Caleffi M, Polanczyk CA. [Cost-effectiveness of an organized breast cancer screening program in Southern Brazil]. CAD SAUDE PUBLICA 2015; 29 Suppl 1:S131-45. [PMID: 25402242 DOI: 10.1590/0102-311x00005213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the cost-effectiveness of an organized breast cancer mammographic screening program implemented in Porto Alegre (Núcleo Mama Porto Alegre - NMPOA), Rio Grande do Sul State, Brazil. A Markov model was constructed to estimate the incremental cost-effectiveness ratio of NMPOA compared to current BC diagnosis and care in the Brazilian public health system, in a hypothetical cohort of women aged 40-69 years at risk of developing breast cancer. Model parameters were collected from NMPOA and the national literature. In the NMPOA strategy, effectiveness was modeled taking into account the actual observed screening adherence. Effectiveness was measured in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio in the base case was R$ 13,426 per QALY. This result was not sensitive to variation in the main model parameters in sensitivity analyses. Considering the threshold usually suggested as highly attractive in Brazil, breast cancer screening as performed in NMPOA is cost-effective in cities with high incidence of breast cancer.
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Affiliation(s)
| | - Maira Caleffi
- Instituto de Educação e Pesquisa, Hospital Moinhos de Vento, Porto Alegre, Brasil
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Wang F, Yu ZG. Current status of breast cancer prevention in China. Chronic Dis Transl Med 2015; 1:2-8. [PMID: 29062980 PMCID: PMC5643782 DOI: 10.1016/j.cdtm.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Zhi-Gang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
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Mo PKH, Mak WWS, Chong ESK, Shen H, Cheung RYM. The prevalence and factors for cancer screening behavior among people with severe mental illness in Hong Kong. PLoS One 2014; 9:e107237. [PMID: 25268752 PMCID: PMC4182090 DOI: 10.1371/journal.pone.0107237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/07/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Screening is useful in reducing cancer incidence and mortality. People with severe mental illness (PSMI) are vulnerable to cancer as they are exposed to higher levels of cancer risks. Little is known about PSMI's cancer screening behavior and associated factors. The present study examined the utilization of breast, cervical, prostate, and colorectal cancer screening among PSMI in Hong Kong and to identify factors associated with their screening behaviors. METHOD 591 PSMI from community mental health services completed a cross-sectional survey. RESULTS The percentage of cancer screening behavior among those who met the criteria for particular screening recommendation was as follows: 20.8% for mammography; 36.5% for clinical breast examination (CBE); 40.5% for pap-smear test; 12.8% for prostate examination; and 21.6% for colorectal cancer screening. Results from logistic regression analyses showed that marital status was a significant factor for mammography, CBE, and pap-smear test; belief that cancer can be healed if found early was a significant factor for pap-smear test and colorectal screening; belief that one can have cancer without having symptoms was a significant factor for CBE and pap-smear test; belief that one will have a higher risk if a family member has had cancer was a significant factor for CBE; and self-efficacy was a significant factor for CBE and pap-smear test behavior. CONCLUSIONS Cancer screening utilization among PSMI in Hong Kong is low. Beliefs about cancer and self-efficacy are associated with cancer screening behavior. Health care professionals should improve the knowledge and remove the misconceptions about cancer among PSMI; self-efficacy should also be promoted.
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Affiliation(s)
- Phoenix Kit Han Mo
- Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Winnie Wing Sze Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- * E-mail:
| | - Eddie Siu Kwan Chong
- Department of Psychology, University of Maryland, College Park, College Park, Maryland, United States of America
| | - Hanyang Shen
- School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Rebecca Yuen Man Cheung
- Department of Special Education and Counselling, Hong Kong Institute of Education, Tai Po, New Territories, Hong Kong
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Fan L, Strasser-Weippl K, Li JJ, St Louis J, Finkelstein DM, Yu KD, Chen WQ, Shao ZM, Goss PE. Breast cancer in China. Lancet Oncol 2014; 15:e279-89. [PMID: 24872111 DOI: 10.1016/s1470-2045(13)70567-9] [Citation(s) in RCA: 1021] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The health burden of cancer is increasing in China, with more than 1·6 million people being diagnosed and 1·2 million people dying of the disease each year. As in most other countries, breast cancer is now the most common cancer in Chinese women; cases in China account for 12·2% of all newly diagnosed breast cancers and 9·6% of all deaths from breast cancer worldwide. China's proportional contribution to global rates is increasing rapidly because of the population's rising socioeconomic status and unique reproductive patterns. In this Review we present an overview of present control measures for breast cancer across China, and emphasise epidemiological and socioeconomic diversities and disparities in access to care for various subpopulations. We describe demographic differences between China and high-income countries, and also within geographical and socioeconomic regions of China. These disparities between China and high-income countries include younger age at onset of breast cancer; the unique one-child policy; lower rates of provision and uptake for screening for breast cancer; delays in diagnosis that result in more advanced stage of disease at presentation; inadequate resources; and a lack of awareness about breast cancer in the Chinese population. Finally, we recommend key measures that could contribute to improved health outcomes for patients with breast cancer in China.
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Affiliation(s)
- Lei Fan
- International Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Breast Surgery, Cancer Center and Cancer Institute, Fudan University, Shanghai, China
| | - Kathrin Strasser-Weippl
- International Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria
| | - Jun-Jie Li
- International Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Breast Surgery, Cancer Center and Cancer Institute, Fudan University, Shanghai, China
| | - Jessica St Louis
- International Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dianne M Finkelstein
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ke-Da Yu
- Department of Breast Surgery, Cancer Center and Cancer Institute, Fudan University, Shanghai, China
| | - Wan-Qing Chen
- National Office for Cancer Prevention and Control, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Cancer Center and Cancer Institute, Fudan University, Shanghai, China
| | - Paul E Goss
- International Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Lee H, Li JY, Fan JH, Li J, Huang R, Zhang BN, Zhang B, Yang HJ, Xie XM, Tang ZH, Li H, He JJ, Wang Q, Huang Y, Qiao YL, Pang Y. Risk factors for breast cancer among Chinese women: a 10-year nationwide multicenter cross-sectional study. J Epidemiol 2013; 24:67-76. [PMID: 24270059 PMCID: PMC3872527 DOI: 10.2188/jea.je20120217] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background The characteristics of established risk factors for breast cancer may vary among countries. A better understanding of local characteristics of risk factors may help in devising effective prevention strategies for breast cancer. Methods Information on exposures to risk factors was collected from the medical charts of 4211 women with breast cancer diagnosed during 1999–2008. The distributions of these exposures among regions, and by menopausal status and birth period, were compared with the χ2 test. Crude associations between the selected factors and breast cancer were estimated using the cases in the present study and a representative control population, which was selected from qualified published studies. Results As compared with cases from less developed regions, those from more developed regions were significantly more likely to be nulliparous, had fewer childbirths (P < 0.05), and were less likely to have breastfed (P = 0.08). As compared with premenopausal cases, postmenopausal cases were more likely to be overweight and to have breastfed and had more childbirths (P < 0.05). The number of live births and rate of breastfeeding decreased in relation to birth period (P for trends <0.001). Overweight, late menopause, and family history of breast cancer were significantly associated with breast cancer among Chinese women. Conclusions Breast cancer incidence was associated with nulliparity and history of breastfeeding. Population attributable risks should be assessed, especially for more developed areas and young women. The effects of body mass index, age at menopause, and family history of breast cancer should be given priority during assessment of breast cancer risk among Chinese women.
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Affiliation(s)
- Hui Lee
- West China School of Public Health, Sichuan University
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Kang MH, Park EC, Choi KS, Suh M, Jun JK, Cho E. The National Cancer Screening Program for Breast Cancer in the Republic of Korea: Is it Cost-Effective? Asian Pac J Cancer Prev 2013; 14:2059-65. [DOI: 10.7314/apjcp.2013.14.3.2059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Widjaja E, Li B, Medina LS. Diagnostic evaluation in patients with intractable epilepsy and normal findings on MRI: a decision analysis and cost-effectiveness study. AJNR Am J Neuroradiol 2013; 34:1004-9, S1-2. [PMID: 23391843 DOI: 10.3174/ajnr.a3474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with focal intractable epilepsy and normal MR imaging findings frequently undergo further diagnostic tests to localize the epileptogenic zone. The aim of this study was to determine the cost-effective diagnostic strategy that will identify the epileptogenic zone in patients with suspected focal intractable epilepsy and normal MR imaging findings by using decision analysis. MATERIALS AND METHODS A Markov decision model was constructed by using sensitivities and specificities of test strategies, seizure outcomes following surgical and medical treatment, cost, utilities, probabilities, and standardized mortality ratios. We compared 6 diagnostic test strategies: PET, ictal SPECT, and MEG individually; and combinations of PET+SPECT, PET+MEG, and SPECT+MEG. The outcomes measured were health care costs, QALY, and ICER. One-way and probabilistic sensitivity analyses were conducted to adjust for uncertainties in model parameters. RESULTS The preferred strategies were PET+MEG and SPECT. The health care cost of the baseline strategy (PET+MEG) was $95,612 with 16.30 QALY gained. SPECT cost $97,479 with 16.45 QALY gained and an ICER of $12,934/QALY gained compared with those in PET+MEG. One-way sensitivity analyses showed that the decisions of the model were sensitive to variations in sensitivity and specificity of the test strategies. Probabilistic sensitivity analysis showed that when the willingness to pay was <$10,000, PET+MEG was the favored strategy, but the favored strategy changed to SPECT when the willingness to pay was >$10,000. CONCLUSIONS PET+MEG and SPECT were the preferred strategies in the base case. The choice of test was dependent on the sensitivity and specificity of test strategies and willingness to pay. Further study with a larger sample size is needed to obtain better estimates of sensitivity and specificity of diagnostic tests.
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Affiliation(s)
- E Widjaja
- Diagnostic Imaging and Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
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Huang Y, Kang M, Li H, Li JY, Zhang JY, Liu LH, Liu XT, Zhao Y, Wang Q, Li CC, Lee H. Combined performance of physical examination, mammography, and ultrasonography for breast cancer screening among Chinese women: a follow-up study. ACTA ACUST UNITED AC 2012; 19:eS22-30. [PMID: 22876165 DOI: 10.3747/co.19.1137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to determine which combination of physical examination (pe), mammography (mam), and ultrasonography (us) would optimize breast cancer detection in China. METHODS We conducted a trial of screening with pe, mam, and us among Chinese women 25 years of age and older. All initial screenings using the three modalities were completed within 30 days of each other, and subjects were followed approximately 1 year later. The performances of the three screening methods used alone, in parallel, or in series were compared. Data were analyzed using exact confidence intervals (cis) and the McNemar test. RESULTS Between March 2009 and July 2011, 3028 eligible women completed all study examinations. At a mean follow-up of 1.3 years, 33 breast cancers were identified in the study population. Mammography detected 28 cancers; us, 24 cancers; and pe, 22 cancers. During the follow-up period, 2 false-negative cases occurred clinically. The highest sensitivity for breast cancer screening (93.9%) was achieved by paralleling mam with us, but came at the cost of a higher recall rate (12.15%). Using us alone at the first stage, followed by mam when indicated, offered high specificity (99.4%) and the lowest recall rate (1.82%), which were not reached at the expense of sensitivity (84.8%). Used in series, us and mam achieved a sensitivity similar to that for the same modalities used in parallel (McNemar p > 0.05). CONCLUSIONS Taking limited health resources into consideration, the strategy of screening with us alone at the first stage, followed by mam when indicated, may optimize breast cancer detection in most regions of China.
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Affiliation(s)
- Y Huang
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, PR China
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Otero HJ, Fang CH, Sekar M, Ward RJ, Neumann PJ. Accuracy, risk and the intrinsic value of diagnostic imaging: a review of the cost-utility literature. Acad Radiol 2012; 19:599-606. [PMID: 22342653 DOI: 10.1016/j.acra.2012.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to systematically review the reporting of the value of imaging unrelated to treatment consequences and test characteristics in all imaging-related published cost-utility analyses (CUAs) in the medical literature. MATERIALS AND METHODS All CUAs published between 1976 and 2008 evaluating diagnostic imaging technologies contained in the CEA Registry, a publicly available comprehensive database of health related CUAs, were screened. Publication characteristics, imaging modality, and the inclusion of test characteristics including accuracy, costs, risks, and the potential value unrelated to treatment consequences (eg, reassurance or anxiety) were assessed. RESULTS Ninety-six published CUAs evaluating 155 different imaging technologies were included in the final sample; 27 studies were published in imaging-specialized journals. Fifty-two studies (54%) evaluated the performance of a single imaging modality, while 44 studies (46%) compared two or more different imaging modalities. The most common areas of interest were cardiovascular (45%) and neuroradiology (17%). Forty-two technologies (27%) concerned ultrasound, while 34 (22%) concerned magnetic resonance. Seventy-nine (51%) technologies used ionizing radiation. Test accuracy was reported or calculated for 90% (n = 133 and n = 5, respectively) and assumed perfect (reference test or gold-standard test without alternative testing strategy to capture false-negatives and false-positives) for 8% (n = 12) of technologies. Only 22 studies (23%) assessing 40 imaging technologies (26%) considered inconclusive or indeterminate results. The risk of testing was reported for 32 imaging technologies (21%). Fifteen studies (16%) considered the value of diagnostic imaging unrelated to treatment. Four studies incorporated it as quality-of-life adjustments, while 10 studies mentioned it only in their discussions or as a limitation. CONCLUSIONS The intrinsic value of imaging (the value of imaging unrelated to treatment) has not been appropriately defined or incorporated in the existing cost-utility literature, which could be due to a lack of evidence on the issue. Thus, more research is needed on metrics for a more comprehensive evaluation of diagnostic imaging. Similarly, the incorporation of variations in imaging tests accuracy, inconclusive results and associated risks has lacked uniformity in the cost-utility literature. Acknowledgment of these characteristics in future cost-utility publications will enhance their value and provide results that more closely resemble routine clinical practice.
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Affiliation(s)
- Hansel J Otero
- Department of Radiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
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Wong IOL, Tsang JWH, Cowling BJ, Leung GM. Optimizing resource allocation for breast cancer prevention and care among Hong Kong Chinese women. Cancer 2012; 118:4394-403. [PMID: 22359352 DOI: 10.1002/cncr.27448] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/30/2011] [Accepted: 12/28/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recommendations about funding of interventions through the full spectrum of the disease often have been made in isolation. The authors of this report optimized budgetary allocations by comparing cost-effectiveness data for different preventive and management strategies throughout the disease course for breast cancer in Hong Kong (HK) Chinese women. METHODS Nesting a state-transition Markov model within a generalized cost-effectiveness analytic framework, costs and quality-adjusted life-years (QALYs) were compared to estimate average cost-effectiveness ratios for the following interventions at the population level: biennial mass mammography (ages 40-69 years or ages 40-79 years), reduced waiting time for postoperative radiotherapy (by 15% or by 25%), adjuvant endocrine therapy (either upfront aromatase inhibitor [AI] therapy or sequentially with tamoxifen followed by AI) in postmenopausal women with estrogen receptor-positive disease, targeted immunotherapy in those with tumors that over express human epidermal growth factor receptor 2, and enhanced palliative services (either at home or as an inpatient). Usual care for eligible patients in the public sector was the comparator. RESULTS In descending order, the optimal allocation of additional resources for breast cancer would be the following: a 25% reduction in waiting time for postoperative radiotherapy (in US dollars: $5000 per QALY); enhanced, home-based palliative care ($7105 per QALY); adjuvant, sequential endocrine therapy ($17,963 per QALY); targeted immunotherapy ($62,092 per QALY); and mass mammography screening of women ages 40 to 69 years ($72,576 per QALY). CONCLUSIONS Given the lower disease risk and different age profiles of patients in HK Chinese, among other newly emergent and emerging economies with similar transitioning epidemiologic profiles, the current findings provided direct evidence to support policy decisions that may be dissimilar to current Western practice.
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Affiliation(s)
- Irene O L Wong
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China.
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Global breast cancer: the lessons to bring home. Int J Breast Cancer 2011; 2012:249501. [PMID: 22295243 PMCID: PMC3262607 DOI: 10.1155/2012/249501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/26/2011] [Indexed: 11/18/2022] Open
Abstract
Breast cancer is the most common cancer affecting women globally. This paper discusses the current progress in breast cancer in Western countries and focuses on important differences of this disease in low- and middle-income countries (LMCs). It introduces several arguments for applying caution before globalizing some of the US-adopted practices in the screening and management of the disease. Finally, it suggests that studies of breast cancer in LMCs might offer important insights for a more effective management of the problem both in developing as well as developed countries.
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Li WWY, Lam WWT, Wong JHF, Chiu A, Chan M, Or A, Kwong A, Suen D, Chan SWW, Fielding R. Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women. Psychooncology 2011. [DOI: 10.1002/pon.2038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wylie W. Y. Li
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - Wendy W. T. Lam
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - Jennifer H. F. Wong
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - April Chiu
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
| | - Miranda Chan
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - Amy Or
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - Ava Kwong
- Department of Surgery; The University of Hong Kong; Hong Kong
| | - Dacita Suen
- Department of Surgery; The University of Hong Kong; Hong Kong
| | | | - Richard Fielding
- Centre for Psycho-oncological Research and Training; School of Public Health; The University of Hong Kong; Hong Kong
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Carles M, Vilaprinyo E, Cots F, Gregori A, Pla R, Román R, Sala M, Macià F, Castells X, Rue M. Cost-effectiveness of early detection of breast cancer in Catalonia (Spain). BMC Cancer 2011; 11:192. [PMID: 21605383 PMCID: PMC3125279 DOI: 10.1186/1471-2407-11-192] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.
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Affiliation(s)
- Misericordia Carles
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Catalonia, Spain
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Lee SY, Jeong SH, Kim YN, Kim J, Kang DR, Kim HC, Nam CM. Cost-effective mammography screening in Korea: high incidence of breast cancer in young women. Cancer Sci 2009; 100:1105-11. [PMID: 19320639 PMCID: PMC11159112 DOI: 10.1111/j.1349-7006.2009.01147.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The epidemiological characteristics of breast cancer in Korean women are different from the characteristics reported in Western women. The highest incidence rate occurs in Korean women in their 40s. The purpose of this study was to determine the most cost-effective screening interval and target age range for Korean women from the perspective of the national healthcare system. A stochastic model was used to simulate breast cancer screenings by varying both the screening intervals and the age ranges. The effectiveness of mammography screening was defined as the probability of detecting breast cancer in the preclinical state and the cost was based on the direct cost of mammography screening and the confirmative tests. The age-specific mean sojourn times and the sensitivity of the mammography were applied in the stochastic model. An optimal cost-effectiveness was determined by the incremental cost-effectiveness ratio and lifetime schedule sensitivity. Sensitivity analyses were undertaken to assess parameter uncertainty. The selected cost-effective strategies were: (1) the current biennial mammography screenings for women who are at least 40 years old; (2) biennial screening for women between the ages of 35 and 75 years; and (3) a combination strategy consisting of biennial screening for women aged between 45 and 54 years, and 3-year interval screening for women aged between 40 and 44 years and 55 and 65 years. Further studies should follow to investigate the effectiveness of mammography screening in women younger than 40 years in Asia as well as in Korea.
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Affiliation(s)
- Soon Young Lee
- Department of Preventive Medicine and Public Health, School of Medicine, Ajou University, Suwon, Korea
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