Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
School of Public Health, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
BMJ Health Care Inform. 2021 Jul;28(1). doi: 10.1136/bmjhci-2021-100351.
Argentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country's Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.
A cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.
It was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.
Tele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.
There is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.
阿根廷是一个中低收入国家（LMIC），其医疗保健系统高度分散，与该国全民健康覆盖计划所规定的获得医疗保健的机会相冲突。远程乳房 X 光摄影网络可以改善获得乳腺癌筛查的机会，降低其死亡率。本研究旨在对实施远程乳房 X 光摄影计划以改善获得医疗保健的机会进行经济评估。
进行成本效益分析，以探索每年对 40 岁以上高危阿根廷女性进行远程乳房 X 光摄影筛查的增量效益。开发了一个马尔可夫模型，以模拟两个假设的无症状女性人群基础队列中的年度乳房 X 光摄影或远程乳房 X 光摄影筛查。通过确定性和概率敏感性分析评估参数不确定性。还探索了模型结构不确定性，以检验结果的稳健性。
预计每年乳房 X 光摄影可发现 31 例新乳腺癌病例，而远程乳房 X 光摄影可发现 39 例。该模型返回的增量成本效益比（ICER）为每质量调整生命年（QALY）26051 英镑，低于世界卫生组织（WHO）为阿根廷推荐的每 QALY26288 英镑的阈值。确定性敏感性分析表明，ICER 对筛查测试的采用率和敏感性最为敏感。概率敏感性分析表明，远程乳房 X 光摄影在 59%的模拟中具有成本效益。
应考虑采用远程乳房 X 光摄影，因为它可以改善在服务不足地区获得专业知识的机会，这些地区对筛查方案的遵守情况较差。需要按省份细分数据，以便做出更明智的政策决策。在医疗系统承受压力（如当前 COVID-19 大流行期间）时，远程医疗也可以有助于确保护理的连续性。
与乳房 X 光摄影相比，远程乳房 X 光摄影对 40 岁以上高危阿根廷女性有 59%的可能性具有成本效益，应该采用该方法来改善该国服务不足地区获得医疗保健的机会。
