Abstract
ObjectiveThe present paper estimates the cost-effectiveness of population-based breast cancer (BC) screening strategies in Brazil for women under 50 years from the perspective of the Brazilian public health system.MethodsA Markov model, simulating the natural history of female BC sufferers in Brazil, was developed. This model compares the lifetime effects, costs, and cost-effectiveness of seven BC screening strategies in women between 40 to 49 years: (A) usual care; (B) annual screen-film mammography (SFM); (C) SFM every 2 years; (D) annual full-field digital mammography (FFDM); (E) FFDM every 2 years; and (F and G) age-targeted options, with FFDM annually until 49 years and SFM annually (or biannually) from 50 to 69 years.ResultsAdopting SFM every 2 years (Strategy C) was found to be slightly more costly but also more effective in terms of quality-adjusted life years (QALYs), yielding an incremental cost-effectiveness ratio (ICER) of R$ 1,509 per QALY gained. Annual SFM (Strategy B) was the next best option at an additional R$ 13,131 per QALY gained. FFDM annual screening (Strategy E) was dominated by Strategy F, the age-targeted option. For younger women, the age-based strategy had an ICER of R$ 30,520 per QALY gained. In the sensitivity analysis, the ICERs ranged from R$ 15,300 to R$ 257,899 in different regions of the country, depending on BC incidence, population age distribution, and mammography coverage.ConclusionsSFM every 2 years for all women starting between the ages of 40 and 49 would be a cost-effective strategy. Taking into account regional specificities, age-targeted FFDM is one option to improve the outcomes of BC patients in an emerging country.
Highlights
Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer among females, accounting for 23% of total cancer diagnoses and 14% of overall cancer deaths (Jemal A et al 2011)
All other screening strategies were associated with higher quality-adjusted life years (QALYs) and additional costs
The discounted QALYs for the seven strategies were similar to those found in previous BC screening studies, while the differences between these strategies were small (Tosteson et al 2008; Rojnik et al 2008)
Summary
Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer among females, accounting for 23% of total cancer diagnoses and 14% of overall cancer deaths (Jemal A et al 2011). Major advances in the early diagnosis of some cancers and a better understanding of the pathogenesis of the disease have led to risk reduction and prevention strategies. These advances as well as improvements in therapy have all contributed to declines in cancer-related death rates (Jemal et al 2008). These successes have come with substantial increases in cost, causing a serious financial burden on patients, families, and society at large (Meropol et al 2009). Effective early detection strategies are preferred to adjuvant therapies because they result in less morbidity
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