Department of Health Policy & Management, City University of New York School of Public Health, New York, NY, USA.
Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
J Cancer Educ. 2022 Jun;37(3):701-708. doi: 10.1007/s13187-020-01871-6. Epub 2020 Sep 27.
Breast cancer is the second incident and second cause of cancer mortality among women in Tanzania due to late-stage presentation. The screening clinic at the Ocean Road Cancer Institute (ORCI) can help detect cases early and reduce cost of treatment. We calculated the return on investment (ROI) of the ORCI breast screening clinic. Screening and treatment data of all newly diagnosed breast cancer patients seen at ORCI during 2016-2018 were abstracted from the medical records. Also, data on time, resources, and cost of screening and treatment were obtained. The cost of treating screened patients was compared with cost of treating unscreened patients, and differences in cost of treatment were compared with cost of operating the screening program. Of the 730 total patients, 58 were screened prior to treatment, and 672 were not. There was no significant difference between stage at diagnosis and treatments received by screened and unscreened patients (79.3% late- stage vs 72.2% late-stage diagnosis, respectively (p = .531), or cost of treatment between the two groups (cost, in Tanzanian Shillings, for screened (2,167,155.14 or $954.27) vs unscreened (1,918,592.28 or $844.52), (p = .355). There was also no significant difference in cost of treatment between the screened and unscreened groups and a slightly negative ROI (- 0.05%) from implementing the program. The breast screening clinic in Tanzania has not yet proven its cost-effectiveness in reducing stage with screening. The likelihood that patients have utilized the clinic for treatment rather than early detection is a possible reason for the lack of cost-effectiveness. Future studies should focus on educational initiatives to encourage screening at early disease stage. Public education should increase awareness about the clinic for early detection. The experience of this program is ideal for dissemination to other low-income countries that are initiating cancer early detection and cancer education programs.
在坦桑尼亚，由于晚期出现，乳腺癌是女性癌症死亡的第二大事件和第二大原因。海洋路癌症研究所（ORCI）的筛查诊所可以帮助早期发现病例并降低治疗成本。我们计算了 ORCI 乳腺癌筛查诊所的投资回报率（ROI）。从病历中提取了 2016 年至 2018 年期间在 ORCI 就诊的所有新诊断乳腺癌患者的筛查和治疗数据。还获得了筛查和治疗的时间、资源和成本数据。将接受筛查的患者的治疗成本与未接受筛查的患者的治疗成本进行比较，并将治疗成本的差异与筛查计划的运营成本进行比较。在 730 名患者中，58 名在治疗前接受了筛查，672 名未接受筛查。接受筛查和未接受筛查的患者的诊断时分期和治疗方法没有显著差异（分别为 79.3%和 72.2%为晚期诊断（p=0.531），或两组之间的治疗费用（接受筛查的患者（2167155.14 坦桑尼亚先令或 954.27 美元）与未接受筛查的患者（1918592.28 坦桑尼亚先令或 844.52 美元）之间没有显著差异（p=0.355）。筛查组和未筛查组之间的治疗费用也没有显著差异，实施该方案的投资回报率略为负数（-0.05%）。坦桑尼亚的乳腺癌筛查诊所尚未证明通过筛查降低分期的成本效益。患者是否因为治疗而非早期检测而利用该诊所，这可能是该诊所缺乏成本效益的原因。未来的研究应侧重于开展教育计划，以鼓励在疾病早期进行筛查。公共教育应提高对该诊所早期检测的认识。该计划的经验非常适合向其他正在启动癌症早期检测和癌症教育计划的低收入国家传播。
