Cost-Effectiveness Analysis of Breast Cancer Screening for Women in Taiwan

• Main Authors: Pei Liu, 劉沛
• Other Authors: Senyeong Kao
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/80629950389361562121

碩士 === 國防醫學院 === 公共衛生學研究所 === 93 === The incidence and mortality of breast cancer are increasing rapidly in Taiwan and developed countries. Breast cancer screening programs have been set up in many countries in order to prevent the mortality. Starting from July 2004, biennial mammography screening was provided by the National Health Insurance in Taiwan for aged 50 to 69. However, the age of onset in Taiwan is much younger then their counterpart in western countries. There is the highest incidence of breast cancer among women between 40 and 50 years in Taiwan. Accordingly, purposes of this study were to evaluate the feasibility of extending screening guidelines to include women 40 to 49 years old, and in what groups, screening interval, and tools are optimal among this years of age. This study conducted the cost-effectiveness analysis (CEA) from a societal perspective by using the Markov model. Health women aged 30 years and older were entry into the model. This analysis assessed the lifetime cost and effects of the preventive interventions. The length of each cycle was one year. We included four costs: the cost of health care resources, the cost of non-health care resources, the cost of informal caregiver time, and the cost of patient time. The outcomes were years of life gained and quality-adjusted life years (QALYs) gained. There were forty-four different strategies according to the screening age, groups, interval, and tools. Based on these strategies, this study compared the incremental cost-effectiveness ratio of screening in women aged 40 to 69 years with 50 to 69 years, the current beneficiaries. As compared to the screening strategy of ages 50 to 69 years, the incremental cost-effectiveness ratios for ages 40 to 69 years were from NT$1,851,492.54 to NT$10,004,880.38 per year of life saved and from NT$5,723,404.26 to NT$20,610,000.00 per year of life saved when discounting costs and effects measured. Accordingly, The dominant screening strategies of ages 40 to 49 years were ultrasonography annually for high risk group, ultrasonography biennially for high risk group, ultrasonography annually for the target subpopulation, ultrasonography triennially for high risk group, ultrasonography biennially for the target subpopulation, ultrasonography triennially for the target subpopulation, clinical breast examination and ultrasonography annually for high risk group, and screening clinical breast examination and ultrasonography annually for the target subpopulation. The incremental cost-effectiveness ratios of these dominant strategies were from NT$5,723,404.26 to NT$8,908,457.54 per year of life saved. Whilst considering the outcome of QALYs, every strategy compared with no screening was less effective; moreover, the screening strategies of ages 40 to 69 years were less than those of ages 50 to 69 years. Extending screening policies to include women 40 to 49 years of age certainly increases early stages of breast cancer cases to be detected, and then women save years of life due to early diagnosis and treatment. But breast cancer is relatively rare disease and low incidence in Taiwan. As a result, the effects of preventive interventions contribute only to a few women with high expenditure should be taking into account. Moreover, resulting from the false positive of screening, women may get stress, distress, and more cost of the erroneous diagnoses. Although life is invaluable, policymaker needs to keep the balance between costs and effects based on the situation of deficit financing of health care systems. There are measures forming a complete set such as quality management, when screening policies put into practice. The quality control and assurance system has being set up for mammography in Taiwan, but still not in the case for clinical breast examination and ultrasonography. The regulation of quality management should be important, if screening clinical breast examination and ultrasonography for women aged 40 to 49 years are put into practice. Furthermore, some investigators indicate that ultrasonography might be a better screening tool because of dense breasts of women in Taiwan. However, we do not have any supporting clinical trial reports regarding ultrasonography to date. Therefore, policymakers should be more cautious when making decisions and try to set up the national evidence.