Özmen Vahit, Gürdal Sibel Ö, Cabioğlu Neslihan, Özcinar Beyza, Özaydın A Nilüfer, Kayhan Arda, Arıbal Erkin, Sahin Cennet, Saip Pınar, Alagöz Oğuzhan
Department of Surgery, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey.
Departments of Surgery, Namık Kemal University School of Medicine, Tekirdağ, Turkey.
Eur J Breast Health. 2017 Jul 1;13(3):117-122. doi: 10.5152/ejbh.2017.3528. eCollection 2017 Jul.
We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey.
Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP.
A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis.
Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.
我们利用巴赫切希尔乳腺钼靶筛查项目（BMSP）前三轮筛查的结果，该项目为期10年（2009 - 2019年），是在土耳其伊斯坦布尔一个县实施的首个有组织的基于人群的筛查项目，以评估土耳其基于人群的乳腺钼靶筛查项目的潜在成本效益。
比较了两种筛查策略：BMSP（包括对40 - 69岁女性进行三次两年一次的筛查）和土耳其国家乳腺癌登记项目（TNBCRP），后者不包括有组织的基于人群的筛查。成本使用BMSP项目的直接数据和土耳其社会保障局的报销率进行估算。通过BMSP观察到的分期分布和TNBCRP估算BMSP节省的生命年数。
在BMSP中，共7234名接受筛查的女性中有67名被诊断患有乳腺癌。AJCC分期0、I、II、III、IV期的分布在BMSP中分别为19.4%、50.8%、20.9%、7.5%、1.5%，在TNBCRP中分别为4.9%、26.6%、44.9%、20.8%、2.8%。预计BMSP项目比TNBCRP多挽救279.46个生命年，额外成本为677171美元，这意味着每挽救一个生命年的增量成本效益比（ICER）为2423美元。由于ICER小于土耳其人均国内生产总值（2014年为10515美元），BMSP项目具有很高的成本效益，并且在敏感性分析中仍然具有成本效益。
乳腺钼靶筛查可能会改变土耳其乳腺癌的分期分布。此外，有组织的基于人群的筛查项目在土耳其和其他发展中国家可能具有成本效益。需要更多研究来更好地估算筛查挽救的生命年数，并进一步验证我们研究的结果。
