Wu F, Mo M, Qin X X, Fang H, Zhao G M, Liu G Y, Chen Y Y, Cao Z G, Yan Y J, Lyu L L, Xu W H, Shao Z M
Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200032, China; Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2017 Dec 10;38(12):1665-1671. doi: 10.3760/cma.j.issn.0254-6450.2017.12.017.
To determine the most cost-effective modality for breast cancer screening in women living in Shanghai. A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness. The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product. Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China. Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.
为确定上海女性乳腺癌筛查最具成本效益的方式。基于真实效果重新开发了一个乳腺癌马尔可夫模型，该真实效果源自一项针对乳腺癌高危女性检测的项目以及2008年至2012年期间在上海闵行区同时开展的有组织的乳腺癌筛查项目。模型参数来源于文献。运用成本效益分析的一般原则，比较了100,000名45岁女性模拟队列中12种不同筛查方式的成本和效果。采用增量成本效益比（ICER）来确定最具成本效益的方式。进行敏感性分析以评估这些因素如何影响估计的成本效益。结果发现，每两年进行一次临床乳腺检查（CBE），对CBE结果呈阳性者随后进行超声和乳腺X线摄影检查的方式是最具成本效益的。每获得一个生命年的成本为182,526元人民币，每节省一个质量调整生命年（QALY）的成本为144,386元人民币，均在当地人均国内生产总值2至3倍的阈值范围内。敏感性分析结果表明，由于上海乳腺癌发病率较高，上海每QALY的成本比中国平均水平低64,836元人民币。我们的研究结果表明，每两年进行一次CBE检查，对CBE结果呈阳性者随后进行超声和乳腺X线摄影检查的项目可能是居住在上海的中国女性最佳的乳腺癌筛查方式，因此可在其他地方的该人群中广泛推广。
