Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review

Icanervilia, Ajeng Viska; Schans, Jurjen van der; Cao, Qi; Carvalho, Adriana C de; Cordova-Pozo, Kathya; Thobari, Jarir At; Postma, Maarten; Asselt, Antoinette DI van

doi:10.7189/jogh.12.04048

Cited by 8 publications

(3 citation statements)

References 52 publications

(111 reference statements)

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“…One of the most challenging for early breast cancer detection is the cost of screening ( 4 ). A systematic review has found that mammography is a cost-effective breast cancer screening method in LMICs in Asia, especially in upper-middle-income countries with the target population of 50–59 years ( 58 ).…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life in breast cancer patients in low-and-middle-income countries in Asia: a systematic review

Ngo

Nguyễn

Nguyen

et al. 2023

Front. Glob. Womens Health

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IntroductionBreast cancer remains one of the major cancers worldwide. In Asia, breast cancer is leading both incidence and mortality rates. Health-related quality of life (HRQoL) studies play an important role in clinical treatment. This systematic review aimed to summarize the evidence of HRQoL and associated factors among patients with breast cancer in low-and-middle-income countries (LMICs) in Asia.MethodPerformed according to PRISMA guidelines for systematic review, the studies were searched from three databases (PubMed, Cochrane, Scopus) up to November 2020. The studies which met the predefined eligibility criteria were selected, extracted, and assessed the quality according to the Newcastle—Ottawa Scale (NOS) tool.Results and DiscussionA total of 2,620 studies were searched on the three databases, of which 28 met the selection criteria, then, were included in the systematic review. The Global Health Status (GHS) score of breast cancer patients based on the EORTC QLQ-C30 questionnaire ranged from 56.32 ± 25.42 to 72.48 ± 15.68. The overall HRQoL scores using the FACT-G and FACT-B instruments ranged from 60.78 ± 13.27 to 82.23 ± 12.55 and from 70.29 ± 13.33 to 108.48 ± 19.82, respectively. Factors affecting HRQoL of patients with breast cancer included age, education level, income, marital status, lifestyle, tumor stage, method, and treatment duration. Patient's income showed a consistent effect on HRQoL while the remaining factors reported inconsistent findings across the studies. In conclusion, the HRQoL of breast cancer patients in LMICs in Asia was low and affected by several sociodemographic factors which should be studied more in future research.

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Section: Discussionmentioning

confidence: 99%

Health-related quality of life in breast cancer patients in low-and-middle-income countries in Asia: a systematic review

Ngo

Nguyễn

Nguyen

et al. 2023

Front. Glob. Womens Health

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“…(7,8) Digital mammography has been studied as a cost-efficient method of breast cancer screening especially for population < 50 years old and for asymptomatic women with average risk for breast cancer. (9,10) Digital mammography was found to have a 97% sensitivity and 64.5% specificity when compared to histopathology as a gold standard. (11) The latest study in Netherlands stated that the use of biennial digital mammography is still more costeffective than the use of digital breast tomosynthesis for a certain maximum threshold per life-year gained.…”

Section: Introductionmentioning

confidence: 98%

Effectiveness and Cost-Effectiveness of Double Reading in Digital Mammography Screening: A Systematic Review and Meta-Analysis

Tjiayadi

Theresia²

2023

JARMHS

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Background: Female breast cancer has become the global leading cause of cancer-related mortality. Although digital mammography has been proposed as an effective and cost-efficient screening method, its real performance and cost-benefit value has been debated by several studies especially concerning the available reading methods. Double reading of digital mammography has been said to increase reading sensitivity but often found some challenges in terms of cost and false positive rate. This systematic review and meta-analysis aim to evaluate the effectiveness and cost-effectiveness of double reading for digital mammography screening. Methods: This review included comparative studies and cost-effectiveness studies from databases such as Pubmed and Cochrane up to April 2023. We excluded non-English studies, cost-effectiveness studies with lacking adequate statistics, single-armed trials, study protocols, earlier meta-analyses, review articles, and studies that merely evaluated double reading of two different methodologies. Study quality was assessed using the QUADAS-2 tool and CHEERS 2022 checklist. Meta-analysis was conducted to evaluate cancer detection and false positive rate of double reading. Ten studies were included in this review, three of which were obtained from a reference article. Mammograms in this review were obtained from a total of 260,501 women. Double reading had a slightly but significant chance of finding a breast cancer (OR = 1.137; p-value = 0.004). False-positive rate in double reading was also prominent (ER = 0.041; p value = 0.000). Single reading with CAD was still proven to be a more cost-effective method. Discussion: Studies in this review was generally had low risk of bias and applicability concern. High cost of double reading may be attributed to the high number of false positive result. Integration of CAD with AI or deep learning may enhance the performance of digital mammography single reading. Conclusion: with consensus and arbitration, double reading strategy present itself as a screening method for breast cancer, however single reading with CAD has proven more superior as a more-cost effective method.

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“…As is well known, on the one hand, the breast cancer mammography screening strategy by population-based had been widely implemented in developed regions for few decades. A systematic review reported eighteen researches reported that breast cancer screening by mammography was regarded as a cost-effective strategy and almost 70% researches were implemented in upper income and middle income regions 19 . On the other hand, perhaps because of less developed regions have limited resources compared to developed regions, whether the breast cancer screening by mammography could be effective and cost-effectiveness is still unclear, and even an intractable problem 20 , 21 .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness evaluation of risk-based breast cancer screening in Urban Hebei Province

Shi

Guan

Liang

et al. 2023

Sci Rep

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To evaluate the implementations of Cancer Screening Program in Urban Hebei and to model the cost-effectiveness of a risk-based breast Cancer Screening Program. Women aged 40–74 years were invited to participate the Cancer Screening Program in Urban Hebei form 2016 to 2020 by completing questionnaires to collect information about breast cancer exposure. Clinical screening including ultrasound and mammography examination were performed. We developed a Markov model to estimate the lifetime costs and benefits, in terms of quality-adjusted life years (QALY), of a high-risk breast Cancer Screening Program. Nine screening strategies and no screening were included in the study. The age-specific incidence, transition probability data and lifetime treatment costs were derived and adopted from other researches. Average cost-effectiveness ratios (ACERs) were estimated as the ratios of the additional costs of the screening strategies to the QLYG compared to no screening. Incremental cost-effectiveness ratios (ICERs) were calculated based on the comparison of a lower cost strategies to the next more expensive and effective strategies after excluding dominated strategies and extendedly dominated strategies. ICERs were used to compare with a willingness-to-pay (WTP) threshold. Sensitivity analysis was explored the influence factors. A total of 84,029 women completed a risk assessment questionnaire, from which 20,655 high-risk breast cancer females were evaluated, with a high-risk rate of 24.58%. There were 13,392 high-risk females completed the screening program, with participation rate was 64.84%. Undergoing ultrasound, mammography and combined screening, the suspicious positive detection rates were 15.00%, 9.20% and 19.30%, and the positive detection rates were 2.11%, 2.76% and 3.83%, respectively. According to the results by Markov model, at the end of 45 cycle, the early diagnosis rates were 55.53%, 60.68% and 62.47% underwent the annual screening by ultrasound, mammography and combined, the proportion of advanced cancer were 17.20%, 15.85% and 15.36%, respectively. Different screening method and interval yield varied. In the exploration of various scenarios, annual ultrasound screening is the most cost-effective strategy with the ICER of ¥116,176.15/QALY. Sensitivity analyses demonstrated that the results are robust. Although it was not cost effective, combined ultrasound and mammography screening was an effective strategy for higher positive detection rate of breast cancer. High-risk population-based breast cancer screening by ultrasound annually was the most cost-effective strategy in Urban Hebei Province.

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Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review

Cited by 8 publications

References 52 publications

Health-related quality of life in breast cancer patients in low-and-middle-income countries in Asia: a systematic review

Health-related quality of life in breast cancer patients in low-and-middle-income countries in Asia: a systematic review

Effectiveness and Cost-Effectiveness of Double Reading in Digital Mammography Screening: A Systematic Review and Meta-Analysis

Cost-effectiveness evaluation of risk-based breast cancer screening in Urban Hebei Province

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