Análise de Custo-efetividade do rastreamento do câncer de mama com mamografia convencional, digital e ressonância

Abstract

A cost-effectiveness analysis was conducted in screening for breast cancer. The use of conventional mammography, digital and magnetic resonance imaging were compared with natural disease history as a baseline. A Markov model projected breast cancer in a group of 100,000 women for a 30 year period, with screening every two years. Four distinct scenarios were modeled: (1) the natural history of breast cancer, as a baseline, (2) conventional film mammography, (3) digital mammography and (4) magnetic resonance imaging. The costs of the scenarios modeled ranged from R$ 194.216,68 for natural history, to R$ 48.614.338,31, for screening with magnetic resonance imaging. The difference in effectiveness between the interventions ranged from 300 to 78.000 years of life gained in the cohort. The ratio of incremental cost-effectiveness in terms of cost per life-year gains, conventional mammographic screening has produced an extra year for R$ 13.573,07. The ICER of magnetic resonance imaging was R$ 2.904.328,88, compared to no screening. In conclusion, it is more cost-effective to perform the screening with conventional mammography than other technological interventions.

Custo-efetividade de um programa de rastreamento organizado de câncer de mama no Sul do Brasil

“…Até o momento, havia apenas um estudo que tinha realizado a avaliação econômica do rastreamento mamográfico em cenário nacional, porém comparando cenários pouco verossímeis -um com 100% e outro com 0% de realização de mamografia 9 . A maioria dos trabalhos internacionais também utilizou apenas esses cenários 7,29,30 .…”

“…No Brasil, apenas um estudo publicado até agora avaliou o custo-efetividade do rastreamento mamográfico, porém comparando cenários de 100% e 0% de adesão ao rastreamento 9 -ambos pouco plausíveis. A relação de custo-efetividade incremental encontrada foi de R$ 13.573,00 por ano de vida ganho.…”

Osgood-schlatter Disease Diagnosis by Algometry and Infrared Thermography

“…Radiographic exams are usually unchanged in OS Syndrome, and only in severe cases can be observed the intratendinose ossicle, but this clinical sign is not unique to OS [14]. The nuclear magnetic resonance imaging (MR) was proven useful to reveal the initial lesions and the progressive lesions of OS syndrome [5], However, the disadvantages of MR are still the high cost of the exam, and the consuming time that implicates [15]. Thermography has advantages like the speed of data collection, the image evaluation in real time, the radiation is not harmful, and does not require contact with the part inspected during the collection [16].…”

What do Cochrane systematic reviews say about the clinical effectiveness of screening and diagnostic tests for cancer?

“…Search strategy in Cochrane Library. December 19, 2016 #1 "Screening" in title, abstract, keywords #2 "Mass Screening" in title, abstract, keywords #3 "Early Detection of Cancer" in title, abstract, keywords #4 " Screen test" in title, abstract, keywords #5 "Screen" in title, abstract, keywords #¨6 #1 OR #2 OR #3 OR #4 OR #5 #7 #¨6 in Cochrane Reviews General population RCT (8) Controlled trial (1) No reduction of lung cancer mortality.…”

“…4 For example, although magnetic resonance imaging may have higher efficacy for detection of breast cancer, compared with conventional mammography, the infrastructure cost and the high number of false-positive results considerably increases its costs and harm, thus leading to a preference for conventional mammography. 8 Finally, screening strategies should be implemented only in settings in which further investigation and treatment are warranted for all individuals, whenever necessary. Otherwise, there is no benefit even for evidence-based screening protocols.…”