Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project

Ozmen,; Sö, Gürdal; Cabıoğlu, Neslihan; Özçınar, Beyza; An, Özaydın; Kayhan, Arda; Arıbal, Erkin; Şahin, Cennet; Saip, Pınar; Alagöz, Oğuzhan

doi:10.5152/ejbh.2017.3528

Cited by 24 publications

(31 citation statements)

References 26 publications

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“…In addition, our screening program also was cost-effective in Turkey, which may be attributed to the early treatment modalities. 41 Studies are needed to investigate whether our results might be relevant and adaptable to other Asian countries to establish policy recommendations on breast cancer early-detection strategies. 42 , 43 …”

Section: Discussionmentioning

confidence: 98%

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçeşehir (Istanbul) Breast Cancer Screening Project in Turkey

Cabıoğlu

Gürdal

Kayhan

et al. 2020

JCO Global Oncology

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PURPOSE The Turkish Bahçeşehir Breast Cancer Screening Project was a 10-year, organized, population-based screening program carried out in Bahçeşehir county, Istanbul. Our aim was to examine the biologic features and outcome of screen-detected and interval breast cancers during the 10-year study period. METHODS Between 2009 and 2019, 2-view mammograms were obtained at 2-year intervals for women aged 40 to 69 years. Clinicopathological characteristics including ER, PR, HER2-neu, and Ki-67 status were analyzed for those diagnosed with breast cancer. RESULTS In 8,758 screened women, 131 breast cancers (1.5%) were detected. The majority of patients (82.3%) had prognostic stage 0-I disease. Contrarily, patients with interval cancers (n = 15; 11.4%) were more likely to have a worse prognostic stage (II-IV disease; odds ratio [OR], 3.59, 95% CI, 0.9 to 14.5) and high Ki-67 scores (OR, 3.14; 95% CI, 0.9 to 11.2). Interval cancers detected within 1 year were more likely to have a luminal B (57.1% v 31.9%) and triple-negative (14.3% v 1%) subtype and less likely to have a luminal A subtype (28.6% v 61.5%; P = .04). Patients with interval cancers had a poor outcome in 10-year disease-specific (DSS) and disease-free survival (DFS) compared with those with screen-detected cancers (DSS: 68.2% v 98.1%, P = .002; DFS: 78.6% v 96.5%, P = .011). CONCLUSION Our findings suggest the majority of screen-detected breast cancers exhibited a luminal A subtype profile with an excellent prognosis. However, interval cancers were more likely to have aggressive subtypes such as luminal B subtype or triple-negative cancers associated with a poor prognosis requiring other preventive strategies.

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Section: Discussionmentioning

confidence: 98%

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçeşehir (Istanbul) Breast Cancer Screening Project in Turkey

Cabıoğlu

Gürdal

Kayhan

et al. 2020

JCO Global Oncology

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“…It was concluded that an organized population-based screening program may be cost-effective in Turkey and in other developing countries. (38) Another study was done in Vietnam 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. Decision analytical modeling was used to estimate costs and health outcomes over a lifetime horizon.…”

Section: Studies On Cost-effectiveness Of Screening Programs For Breamentioning

confidence: 99%

Cost-Effectiveness of National Breast Cancer Screening Programs in Developing Countries, with Reference to the Recent Egyptian Initiative

Wahdan

2020

Journal of High Institute of Public Health

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Breast cancer was the second most common cancer in the world and the most common cancer in women both in developed and less developed world. It ranked the fifth cause of death from all cancers and caused the greatest number of cancer related deaths among women in 2018. A variety of factors have been shown to impact an individual's risk of developing breast cancer and its ultimate prognosis. Screening for breast cancer will help to reduce mortality, to confer lifetime protection, and to protect those with high risk factors. Cost-effectiveness analysis refers to the economic evaluation in which the costs and consequences of alternative interventions are expressed in cost per unit of health outcome. Studies on costeffectiveness of screening programs in developing countries used different methods and calculated different outcome measures. They studied different tools used for screening. Some studied the costeffectiveness of clinical breast examination and others studied that of mammography. The outcome measures varied, some studies calculated the cost-effectiveness ratio, while others calculated the incremental cost-effectiveness ratio, the disability adjusted life years and the quality adjusted life years. It is concluded that although population-based mammography has been widely adopted in high-income countries, it is less cost-effective in low-and middle-income countries which face some challenges such as the problem of investment in screenings. In developing countries, further research to study the cost-effectiveness of breast cancer screening, covering a comprehensive set of interventions and resulting in clear policy recommendations, is required.

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“…To ensure that the modelling analysis was in line with the standard clinical care pathways in Turkey, patients were assumed to receive standard endocrine therapy and chemotherapy regimens in line with local practices evidenced in the Turkish Oncotype-Dx Decision Impact Study and the Turkish Cost-Effectiveness Analysis of Screening in Breast Cancer (8,10). The model cohort age was assumed to be 49.9 years based on the mean age from Turkish Oncotype-Dx Decision Impact Study cohort (8).…”

Section: Clinical Parametersmentioning

confidence: 99%

Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study

Özmen

Çakar

Gökmen

et al. 2019

European Journal of Breast Health

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Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods:A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%. Results:The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the costeffectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice. Conclusion:As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.

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Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project

Cited by 24 publications

References 26 publications

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçeşehir (Istanbul) Breast Cancer Screening Project in Turkey

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçeşehir (Istanbul) Breast Cancer Screening Project in Turkey

Cost-Effectiveness of National Breast Cancer Screening Programs in Developing Countries, with Reference to the Recent Egyptian Initiative

Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study

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