Abstract
BackgroundBreast 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.MethodsMultistate 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).ResultsAll 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.ConclusionScreening 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.
Highlights
Breast cancer is the most common cancer among women worldwide
This study aims to analyze the cost-effectiveness of the annual national screening mammography program for all Ethiopian women age 40 years and above
The standard errors of total costs were 751.41 and 762.720 for age-group 40–49 years and 50–59 years respectively. 78.55 and 107.38 deaths were averted for age group 40–49 years and 50–59 years respectively from screening mammography
Summary
Breast cancer contributes to 24.2% of all cancer diagnoses and 15% of cancer mortality [1, 2] Majority of this burden occurs in low and middle-income countries with more than 60% global annual mortality being recorded in this segment of the world with the reported highest mortality rate from Africa [3, 4]. This is likely from poor resources and manpower compounded. This study aims to analyze the cost-effectiveness of screening mammography in Ethiopia
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