Hutchinson Brian, Watts Rory, Nyangasi Mary, Anderson Benjamin O, Chepchumba Joyfrida, Wangia Elizabeth, Jalang'o Rose, Mwenda Valerian, Yerramilli Pooja, Lee Kuguru Toni, Kabubei Kenneth Munge, Gordillo-Tobar Amparo, Meheus Filip, Meyer Christina, Ilbawi Andre, Nugent Rachel
Center for Global Noncommunicable Diseases, International Development Group, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
Forecast Health, 38 Queen Victoria Street, Fremantle, Western Australia, 6160, Australia.
EClinicalMedicine. 2024 Oct 30;77:102894. doi: 10.1016/j.eclinm.2024.102894. eCollection 2024 Nov.
Cancer is the third leading cause of death in Kenya. Breast cancer is responsible for 3100 deaths annually. Quantifying the economic and social impacts of breast cancer supports inclusion of cancer care within Kenya's universal healthcare plan.
Kenya's Ministry of Health led an economic cost-benefit analysis of expanding breast cancer prevention and treatment services. Three scenarios (early diagnosis only, screening with clinical breast exam (CBE-led), and screening with mammography (MG-led)) were modelled using an adapted version of a deterministic state-transition cohort simulation model jointly developed by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) and maintained by Forecast Health. Real world evidence on the favorable stage-shift induced by each early detection scenario was used as model inputs. The model estimated the mortality benefits of favorable stage-shifting, and net financial costs and health and economic benefits in 2020 USD.
Respectively, over 40 years, the cost to sustain early diagnosis programs only, CBE-led screening, or mammogram-led screening would require 1.4, 2.8, or 5.2 percent increases above current government health spending. All three strategies are economically efficient in the long run. Net economic benefits of expanded breast cancer care using clinical breast exam screening are $2.3 billion dollars (USD) over the next 40 years with 236,000 women's lives saved in Kenya. Mammographic screening provides net benefits of $1.9 billion (USD) with an additional 34,000 lives saved over 40 years compared to the CBE-led screening approach. Over 40 years, an early diagnosis-only strategy saves the fewest lives and has the lowest net benefit among the three strategies.
We offer a novel economic evaluation for breast cancer prevention and care expansion within Universal Health Coverage in Kenya. It demonstrates the economic viability of providing those services in a low-middle income (LMI) context.
The work was funded by the World Bank Group's Tackling Non-Communicable Diseases Challenges in Low- and Middle-Income Countries Trust Fund, supported by the Access Accelerated Partnership. This report was also partially financed by the Global Financing Facility for Women, Children and Adolescents (GFF). The GFF is a global multi-stakeholder partnership hosted at the World Bank that provides catalytic financing and technical support for safe and equitable delivery of essential health and nutrition services for women, children and adolescents, while helping countries to build more resilient health systems.
癌症是肯尼亚第三大死因。乳腺癌每年导致3100人死亡。量化乳腺癌的经济和社会影响有助于将癌症护理纳入肯尼亚的全民医疗保健计划。
肯尼亚卫生部对扩大乳腺癌预防和治疗服务进行了经济成本效益分析。使用世界卫生组织（WHO）和国际癌症研究机构（IARC）联合开发并由Forecast Health维护的确定性状态转换队列模拟模型的改编版本，对三种方案（仅早期诊断、临床乳腺检查（CBE主导）筛查和乳房X线摄影（MG主导）筛查）进行了建模。每种早期检测方案引起的有利分期转移的真实世界证据被用作模型输入。该模型估计了有利分期转移带来的死亡率益处，以及以2020年美元计算的净财务成本、健康和经济效益。
在40年期间，仅维持早期诊断计划、CBE主导的筛查或乳房X线摄影主导的筛查的成本分别需要比政府当前的医疗支出高出1.4%、2.8%或5.2%。从长远来看，这三种策略在经济上都是有效的。在肯尼亚，使用临床乳腺检查筛查扩大乳腺癌护理的净经济效益在未来40年为23亿美元，可挽救23.6万名妇女的生命。与CBE主导的筛查方法相比，乳房X线摄影筛查在40年内提供了19亿美元的净效益，并多挽救了3.4万人的生命。在40年期间，仅早期诊断策略挽救的生命最少，在这三种策略中净效益最低。
我们为肯尼亚全民健康覆盖范围内的乳腺癌预防和护理扩展提供了一种新颖的经济评估。它证明了在中低收入（LMI）背景下提供这些服务的经济可行性。
这项工作由世界银行集团的低收入和中等收入国家应对非传染性疾病挑战信托基金资助，由加速获取伙伴关系提供支持。本报告还部分由全球妇女、儿童和青少年融资机制（GFF）资助。GFF是一个由世界银行主办的全球多利益相关方伙伴关系，为安全、公平地提供妇女、儿童和青少年的基本健康和营养服务提供催化融资和技术支持，同时帮助各国建立更具韧性的卫生系统。
