| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 104 === Abstract
Background
Breast mammography is the standard procedure for breast cancer screening now. Serious of meta-analysis had proved the cost-effectiveness of breast mammography screening in breast cancer-related mortality reduction. Breast mammography screening had been preceded in Taiwan as a breast cancer screening procedure since 2004. To evaluate the cost-effectiveness of the breast mammography program in Taiwan, a single insurance system, we analyzed the cost and effectiveness of breast mammography screening concurrent with incremental cost-effectiveness analysis (ICER).
Method
This is a quasi-experiment design retrospective secondary data analysis study. The longitudinal health insurance database (LHID) 2010 of national health insurance research database (NHIRD) from 2007 to 2012 was acquired. We divided the invasive breast cancer (IBC) patients and the breast ductal carcinoma in situ (DCIS) patients into screening and non-screening groups. IBM statistical product and service solutions (SPSS) 22nd version was adopted as statistic analysis.
Result
There were 3047 IBC and breast DCIS patients detected in 2007 to 2012 LHID.
Cost:
The screening group patients took 485051.3199 standard payment rate (SPR) per patient, which was lesser than the non-screening group patients (527512.2977 SPR) (p=.077) in the entire study population. And the screening group patients in the 50-69-year-old sub-group took 469192.6486 SPR per patient which was significantly lesser than the non–screening group patients’ 550999.6967 SPR (p=.004). But breast mammography screening in the 45-49-year-old group took 416608.9849 SBR per patient which was 40,302.1711 SBR lesser than the non-screening group (p=.351).
Effectiveness:
In the whole study population, the breast DCIS detection rate was 13.52% in the screening group, which was significantly higher than that of the non-screening group (5.84%) (p=.000). Previous detection rate in the 50-69-year-old group was 14.00% versus 4.86 %( p=.000) whereas in the 45-49-year-old group was 14.57% versus 9.00 %( p=.084)
Cost-effectiveness analysis:
The ICER in the 45-49-year-old group was 3358.5 SPR per breast DCIS detection. The ICER in the 50-59-year-old group was 1298.5 SPR per breast DCIS detection, which was 2060 SPR lesser than the 45-49-year-old group.
Conclusion:
Our study demonstrated that breast mammography screening in the 50-69-year-old subgroup was more cost-effectiveness than the 45-49-year-old group in Taiwan.
Key word: Breast mammography screening, cost-effectiveness, incremental cost-effectiveness radial (ICER)
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