Costs and Health Effects of Breast Cancer Interventions in Epidemiologically Different Regions of Africa, North America, and Asia

Abstract

We estimated the costs and health effects of treating stage I, II, III, and IV breast cancer individually, of treating all stages, and of introducing an extensive cancer control program (treating all stages plus early stage diagnosis) in three epidemiologically different world regions--Africa, North America, and Asia. We developed a mathematical simulation model of breast cancer using the stage distribution and case fatality rates in the presence and absence of treatment as predictors of survival. Outcome measures were life-years adjusted for disability (DALYs), costs (in 2000 U.S. dollars) of treatment and follow-up, and cost-effectiveness ratios (CERs; in dollars per DALY averted). Sensitivity analyses were performed to determine the robustness of the results. Treating patients with stage I breast cancer resulted in 23.41, 12.25, and 19.25 DALYs averted per patient in Africa, North America, and Asia, respectively. The corresponding average CERs compared with no intervention were 78 U.S. dollars , 1,960 U.S. dollars, and 62 U.S. dollars per DALY averted. The number of DALYs averted per patient decreased with stage; the value was lowest for stage IV treatment (0.18-0.19), with average CERs of 4,986 U.S. dollars in Africa, 70,380 U.S. dollars in North America, and 3,510 U.S. dollars per DALY averted in Asia. An extensive breast cancer program resulted in 16.14, 12.91, and 12.58 DALYs averted per patient and average CERs of 75 U.S. dollars, 915 U.S. dollars, and 75 U.S. dollars per DALY averted. Outcomes were most sensitive to case fatality rates for untreated patients, but varying model assumptions did not change the conclusions. These findings suggest that treating stage I disease and introducing an extensive breast cancer program are the most cost-effective breast cancer interventions.

Breast Cancer in India: Where Do We Stand and Where Do We Go?

“…In Africa and Asia the treatment of breast cancer in stages I, II or III costs less than U$ 390 per Disability Adjusted Life Years (DALY) averted. If the cancer progresses to stage IV treatment will cost more than 3,500U$ per DALY averted (Groot et al, 2006). Breast cancer treatment in India varies from non existent, to the most updated at power with the developed world.…”

Can We Treat Cancer for a Dollar a Day? Guidelines for Low-Income Countries

“…First, two meta-analyses including 10 new randomized trials show that the risk of acute myocardial infarction is 30 to 80% higher among patients with diabetes taking rosiglitazone than among those receiving placebo. 3,4 In comparisons of rosiglitazone with other antidiabetic agents, such as the sulfonylureas or metformin, the hazard ratio is lower, although it is still greater than 1. In comparison with the FDA's 2007 meta-analysis, the newer analyses showed higher odds ratios for major adverse cardiovascular events, myocardial infarction, and serious ischemic events in patients receiving rosiglitazone (see Table 1).…”

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

“…Management of late-stage breast cancer is more expensive, technically demanding, and results in more morbidity and mortality (M&M) than that of early-stage breast cancer (3,(5)(6)(7)(8). This is true even in high-income countries (HIC).…”