Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
Directorio Médico del INEN, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru.
PLoS One. 2013 Dec 10;8(12):e82575. doi: 10.1371/journal.pone.0082575. eCollection 2013.
In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context.
We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted.
The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective.
Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.
在秘鲁这个医疗资源有限的国家，乳腺癌的治疗以晚期治疗和生存预后较差为特征。为了支持秘鲁的乳腺癌防治工作，本研究旨在确定不同乳腺癌防治干预措施在秘鲁环境下的成本效益。
我们按照世界卫生组织选择（WHO-CHOICE）指南，从医疗保健角度进行了成本效益分析（CEA）。使用数学模型评估了不同的筛查、早期检测、姑息治疗和治疗干预措施。有效性估计基于观察性研究、建模以及国家肿瘤研究所（INEN）的信息。资源利用和单位成本基于 INEN 和观察性研究的估计。成本效益估计以每避免一个残疾调整生命年（DALY）所需的 2012 年美国美元（US$）表示。
秘鲁现有的乳腺癌项目（每避免一个 DALY 需 8426 美元）可以通过实施每三年或两年一次的筛查策略来改善。这些策略在秘鲁似乎是最具成本效益的，特别是当应用移动乳房 X 光检查时（每避免一个 DALY 需 4125 美元），或者当 CBE 筛查和乳房 X 光筛查相结合时（每避免一个 DALY 需 4239 美元）。每三年，这些干预措施每年的成本在 6300 万至 7200 万美元之间。晚期治疗、曲妥珠单抗治疗和年度筛查策略的成本效益最低。
我们的分析表明，秘鲁的乳腺癌防治工作应侧重于通过结合固定和移动乳房 X 光筛查（45-69 岁）每三年一次来进行早期检测。然而，在非城市地区逐步引入每三年一次的 CBE 筛查（40-69 岁），并在城市地区同时开展 CBE（40-49 岁）和固定乳房 X 光筛查（50-69 岁），似乎是一种更可行的选择，并且也具有成本效益。如果同时提高意识、诊断、转诊、治疗和基本姑息治疗服务，并降低这些服务的财务和组织障碍，那么实施这种干预措施才有意义。
Zotero 插件