Breast cancer screening; cost-effective in practice?

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

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Article Commentary: Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future Directions

Breast Cancer Basic and Clinical Research ◽

10.4137/bcbcr.s774 ◽

2008 ◽

Vol 1 ◽

pp. BCBCR.S774 ◽

Cited By ~ 10

Author(s):

A. Sarvazyan ◽

V. Egorov ◽

J.S. Son ◽

C.S. Kaufman

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Imaging Techniques ◽

Clinical Breast Examination ◽

Cost Effective ◽

Cancer Diagnostics ◽

Elasticity Imaging ◽

Diagnostic Potential ◽

Tactile Imaging

Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicine in developing countries is inadequate for the majority of the population. There is a tremendous worldwide need to detect breast cancer at its earliest stage. These needs must be balanced by the ability of countries to provide breast cancer screening technology to their populations. We reviewed the diagnostic accuracy, procedure cost and cost-effectiveness of currently available technique for breast screening and diagnosis including clinical breast examination, mammography, ultrasound, magnetic resonance imaging, biopsy and a new modality for cancer diagnostics termed elasticity imaging that has emerged in the last decade. Clinical results demonstrate that elasticity imaging even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques. In view of many countries with limited resources, effective yet less expensive modes of screening must be considered worldwide. The tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.

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Breast cancer screening by mammography in Norway. Is it cost-effective?

Annals of Oncology ◽

10.1023/a:1008376608270 ◽

1999 ◽

Vol 10 (2) ◽

pp. 197-204 ◽

Cited By ~ 20

Author(s):

J. Norum

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cost Effective

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Cost effectiveness analysis of a polygenic risk tailored breast cancer screening programme in Singapore

BMC Health Services Research ◽

10.1186/s12913-021-06396-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jerry Zeng Yang Wong ◽

Jia Hui Chai ◽

Yen Shing Yeoh ◽

Nur Khaliesah Mohamed Riza ◽

Jenny Liu ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Programme ◽

Cost Effective ◽

Polygenic Risk ◽

Breast Cancer Screening Programme ◽

Cancer Screening Programme ◽

The Cost

Abstract Background This study aimed to evaluate the cost-effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs), against the current biennial mammogram-only screening programme to aid in its implementation into the current programme in Singapore. Methods A Markov model was used to compare the costs and health outcomes of the current screening programme, against a polygenic risk-tailored screening programme, which can advise a long-term screening strategy depending on the individual’s polygenic risk. The model took the perspective of the healthcare system, with a time horizon of 40 years, following women from the age of 35 to 74. Epidemiological and cost data were taken from Asian studies, and an annual discount rate of 3% was used. The model outcome was the incremental cost-effectiveness ratio (ICER), calculated from the difference in costs per quality-adjusted life year (QALY). Scenarios with varying risk thresholds for each polygenic risk group were examined. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty. Results The ICER for a polygenic risk-tailored breast cancer screening programme, compared with the current biennial mammogram-only screening programme, was − 3713.80 SGD/QALY, with incremental costs < 0 and incremental effects > 0. The scenario analysis of different polygenic risk cutoffs showed that the ICERs remain negative, with all ICERs falling within the south-east quadrant of the cost-effectiveness plane, indicating that tailored screening is more cost effective than mammogram-only screening, with lower costs and higher QALYs to be gained. This suggests that a polygenic risk-tailored breast cancer screening programme is cost effective, entailing lower cost than the current mammogram-only programme, while causing no additional harm to women. Conclusion Results from this cost-effectiveness analysis show that polygenic risk-tailored screening is cost effective with an ICER of − 3713.80 SGD/QALY. Tailored screening remains cost effective even across varying percentile cutoffs for each risk group. While the results look promising for incorporating polygenic risk into the current breast cancer screening programme, further studies should be conducted to address various limitations.

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Risk-adapted breast cancer screening and prevention most cost-effective approach in Europe

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-021-07962-9 ◽

2021 ◽

Vol 885 (1) ◽

pp. 20-20

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cost Effective ◽

Cost Effective Approach ◽

Cancer Screening And Prevention ◽

Screening And Prevention

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Breast cancer screening after age 69 is more cost-effective if restricted to women with higher bone mineral density

Evidence-based Obstetrics and Gynaecology ◽

10.1054/ebog.2001.0227 ◽

2001 ◽

Vol 3 (2) ◽

pp. 101-102

Author(s):

Dorte Gyrd-Hansen

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Bone Mineral ◽

Cost Effective ◽

Mineral Density

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Rapid Access to Contrast-Enhanced spectral mammogRaphy in women recalled from breast cancer screening: the RACER trial study design

Trials ◽

10.1186/s13063-019-3867-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

L. M. F. H. Neeter ◽

I. P. L. Houben ◽

P. J. Nelemans ◽

T. J. A. Van Nijnatten ◽

R. M. Pijnappel ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Program ◽

Controlled Trial ◽

Cost Effective ◽

Patient Anxiety ◽

Multicenter Randomized Controlled Trial ◽

Additional Imaging ◽

Work Up

Abstract Background In the Dutch breast cancer screening program, women recalled with a BI-RADS 0 score are referred for additional imaging, while those with BI-RADS 4/5 scores are also directed to an outpatient breast clinic. Approximately six out of ten women are recalled without being diagnosed with a malignancy. However, these recalls require additional imaging and doctor visits, which result in patient anxiety and increased health care costs. Conventional types of imaging used for additional imaging are full-field digital mammography and tomosynthesis. Contrast-enhanced spectral mammography has proved to have higher sensitivity and specificity than conventional imaging in women recalled from screening. Therefore, the aim is to study if CESM instead of conventional imaging is a more accurate, patient-friendly, and cost-effective strategy in the work-up of women recalled from breast cancer screening. Methods This prospective, multicenter, randomized controlled trial will be conducted at four centers and will include 528 patients recalled for suspicious breast lesions from the Dutch breast cancer screening program. Participants are randomized in two groups: (1) standard care using conventional breast imaging techniques as initial imaging after recall versus (2) work-up primarily based on CESM. Written informed consent will be collected prior to study inclusion. The primary outcome is the diagnostic accuracy for detection of breast cancer. Secondary outcomes are numbers of additional diagnostic exams, days until final diagnosis, health care costs, and experienced patient anxiety. Discussion Based on previously published retrospective studies, we expect to demonstrate in this prospective multicenter randomized controlled trial, that using CESM as a primary work-up tool in women recalled from breast cancer screening is a more accurate, cost-effective, and patient-friendly strategy. Trial registration Netherlands Trial Register, NL6413/NTR6589. Registered on 6 July, 2017.

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