College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Med Imaging. 2021 Nov 2;21(1):162. doi: 10.1186/s12880-021-00696-z.
Breast cancer is the most common cancer diagnosed in women. Screening mammography is the only imaging screening study for breast cancer with a proven. mortality benefit. This study aims to analyze the cost-effectiveness of screening mammography in Ethiopia.
Multistate Markov model was used for computer simulation to estimate cost and health benefits of screening mammography interventions for age-group of 40-49 years and 50-59 years. The cost-effectiveness analysis was made for 4 policies based on where the screening mammography procedures were conducted: government institution only, the private institution only, 50% ratio for each, and 10% private institution policy. Outputs were expressed in total cost, life-years gained (LYG) incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB).
All 4 policies of annual screening mammography failed to achieve acceptable ICER and lead to a net loss in INMB. The lowest ICER value was for government institution-only policy with 3510.3 USD/LYG and 3224.9 USD/LYG both above the cost-effectiveness threshold of 2808.5 USD. The cost per single death averted for each group was 110,206.7 USD and 77,088.2 USD for age-group 40-49 years and 50-59 years respectively.
Screening mammography could not be shown to be cost-effective in Ethiopia with the current low cost-effectiveness threshold. Alternative screening approach like annual clinical breast examination may need to be investigated.
乳腺癌是女性最常见的癌症。乳腺 X 线筛查是唯一具有明确降低死亡率获益的乳腺癌影像学筛查研究。本研究旨在分析在埃塞俄比亚进行乳腺 X 线筛查的成本效益。
使用多状态马尔可夫模型进行计算机模拟，以估计 40-49 岁和 50-59 岁年龄组的乳腺 X 线筛查干预的成本和健康效益。基于筛查乳腺 X 线检查的实施地点，针对以下 4 种政策进行成本效益分析：仅政府机构、仅私立机构、各占 50%和 10%私立机构政策。产出以总成本、获得的生命年（LYG）增量成本效益比（ICER）和增量净货币效益（INMB）表示。
所有 4 种年度乳腺 X 线筛查政策都未能达到可接受的 ICER，并导致 INMB 净亏损。政府机构仅政策的最低 ICER 值为 3510.3 美元/LYG 和 3224.9 美元/LYG，均高于 2808.5 美元的成本效益阈值。每组每避免 1 例死亡的成本分别为 110206.7 美元和 77088.2 美元，适用于 40-49 岁和 50-59 岁年龄组。
在埃塞俄比亚，目前的低成本效益阈值下，乳腺 X 线筛查不能被证明是具有成本效益的。可能需要研究替代的筛查方法，如每年的临床乳房检查。
