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Shi J, Guan Y, Liang D, Li D, He Y, Liu Y. Cost-effectiveness evaluation of risk-based breast cancer screening in Urban Hebei Province. Sci Rep 2023; 13:3370. [PMID: 36849794 PMCID: PMC9971026 DOI: 10.1038/s41598-023-29985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
To evaluate the implementations of Cancer Screening Program in Urban Hebei and to model the cost-effectiveness of a risk-based breast Cancer Screening Program. Women aged 40-74 years were invited to participate the Cancer Screening Program in Urban Hebei form 2016 to 2020 by completing questionnaires to collect information about breast cancer exposure. Clinical screening including ultrasound and mammography examination were performed. We developed a Markov model to estimate the lifetime costs and benefits, in terms of quality-adjusted life years (QALY), of a high-risk breast Cancer Screening Program. Nine screening strategies and no screening were included in the study. The age-specific incidence, transition probability data and lifetime treatment costs were derived and adopted from other researches. Average cost-effectiveness ratios (ACERs) were estimated as the ratios of the additional costs of the screening strategies to the QLYG compared to no screening. Incremental cost-effectiveness ratios (ICERs) were calculated based on the comparison of a lower cost strategies to the next more expensive and effective strategies after excluding dominated strategies and extendedly dominated strategies. ICERs were used to compare with a willingness-to-pay (WTP) threshold. Sensitivity analysis was explored the influence factors. A total of 84,029 women completed a risk assessment questionnaire, from which 20,655 high-risk breast cancer females were evaluated, with a high-risk rate of 24.58%. There were 13,392 high-risk females completed the screening program, with participation rate was 64.84%. Undergoing ultrasound, mammography and combined screening, the suspicious positive detection rates were 15.00%, 9.20% and 19.30%, and the positive detection rates were 2.11%, 2.76% and 3.83%, respectively. According to the results by Markov model, at the end of 45 cycle, the early diagnosis rates were 55.53%, 60.68% and 62.47% underwent the annual screening by ultrasound, mammography and combined, the proportion of advanced cancer were 17.20%, 15.85% and 15.36%, respectively. Different screening method and interval yield varied. In the exploration of various scenarios, annual ultrasound screening is the most cost-effective strategy with the ICER of ¥116,176.15/QALY. Sensitivity analyses demonstrated that the results are robust. Although it was not cost effective, combined ultrasound and mammography screening was an effective strategy for higher positive detection rate of breast cancer. High-risk population-based breast cancer screening by ultrasound annually was the most cost-effective strategy in Urban Hebei Province.
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Affiliation(s)
- Jin Shi
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yazhe Guan
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Di Liang
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Daojuan Li
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yutong He
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
| | - Yunjiang Liu
- Department of Breast Cancer Center, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
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Icanervilia AV, van der Schans J, Cao Q, de Carvalho AC, Cordova-Pozo K, At Thobari J, Postma MJ, van Asselt ADI. Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review. J Glob Health 2022; 12:04048. [PMID: 35837900 PMCID: PMC9284087 DOI: 10.7189/jogh.12.04048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strategies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs. Methods A systematic article search was conducted through Medline, Embase, Web of Science, and Econlit. Studies were included only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narratively. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extended checklist. Results This review identified 21 studies economically evaluating mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determining cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combination with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients). Conclusions Mammography screening appeared to be a cost-effective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammography screening in these regions.
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Affiliation(s)
- Ajeng V Icanervilia
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jurjen van der Schans
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands
| | - Qi Cao
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adriana C de Carvalho
- Regenerative Medicine Center Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kathya Cordova-Pozo
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Institute of Management Research, Radboud University, the Netherlands
| | - Jarir At Thobari
- Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands.,Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Antoinette DI van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Askarian M, Dianat S, Tahmasebi S, Jafari A, Hatam N. Cost-Effectiveness of Breast Cancer Screening in Shiraz, Iran. Int J Prev Med 2022; 13:147. [PMID: 36910993 PMCID: PMC9999089 DOI: 10.4103/ijpvm.ijpvm_611_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/20/2021] [Indexed: 03/14/2023] Open
Abstract
Background Breast cancer is the most common cancer in the world, which accounts for 21.4% of all kinds of cancers for women in Iran. However, the treatment of breast cancer is costly and given that the budget devoted to the healthcare sector is limited, the present study aimed to investigate the cost-effectiveness of breast cancer screening for women, who referred to breast clinic located in Shahid Motahari clinic affiliated to Shiraz University of Medical Sciences, Shiraz city, Iran in 2017-2018. Methods This study is a cross-sectional study analyzing the cost-effectiveness of breast cancer screening versus no screening. The study was conducted on 3500 women, who referred to the breast clinic in Motahari clinic, at 2017-2018 in Shiraz, Iran. The patients were identified and direct costs, which were correlated to cancer breast screening, were calculated based on the patients' records with public tariff per person. Tree age pro 2011 used to analyze cost effectiveness. Results Based on the results obtained, the expected cost of screening and no screening were 7556 $ppp and 7840 $ppp, respectively. Given their difference in effectiveness (16%), screening was dominant (less costly and more effective) compared to no screening. Tornado diagram showed that the results had the maximum sensitivity to the increase in screening cost. Conclusions In general, according to the results obtained from the current study, the screening was more cost effective compared with no screening.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, School of Medicine, Nephro-Urology Research Center Internal Medicine Research Institute, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz
| | - Sara Dianat
- Department of Health Management, Student Research Committee, MSc in Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Department of Surgery, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Department of Health Economy, Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Hatam
- Department of Health Management, Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran. BMC Health Serv Res 2021; 21:327. [PMID: 33836724 PMCID: PMC8034109 DOI: 10.1186/s12913-021-06330-6] [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: 11/29/2020] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Abstract
Background Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. Methods In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models. Results This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan. Conclusions The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.
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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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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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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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Bakhtiyrizadeh S, Hosseini SY, Yaghobi R, Safaei A, Sarvari J. Almost Complete Lack of Human Cytomegalovirus and Human papillomaviruses Genome in Benign and Malignant Breast Lesions in Shiraz, Southwest of Iran. Asian Pac J Cancer Prev 2017; 18:3319-3324. [PMID: 29286226 PMCID: PMC5980890 DOI: 10.22034/apjcp.2017.18.12.3319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Breast cancer ranks as the most common cancer among women worldwide. There have been controversial reports regarding contributions of human papillomaviruses (HPVs) and human cytomegalovirus (HCMV) to its development. The aim of this study was to determine the frequency of HPV and HCMV positivity in benign and malignant breast tumors.
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Affiliation(s)
- Sahar Bakhtiyrizadeh
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Investigation of the Association of HOTAIR Single Nucleotide Polymorphisms and Risk of Breast Cancer in an Iranian Population. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.7498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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