Application Of Markov Model In The Health Economic Evaluation Of Breast Cancer Screening

ObjectivesThe method of Markov model is simply introduced in this paper. Take the project of tertiary breast cancer screening and diagnosis system in Guangdong province as an example to make healthy economic evaluation, in order to provide evidence for implementation of breast cancer screening and establish a rational feasible cost-sharing mechanism using Markov decision model.MethodsUsing data from Guangdong rural breast cancer screening project to evaluate the validity and reliability of screening strategies and calculate the number needed to invite for screening. The A group received tertiary breast cancer screening and diagnosis system, while B group received routine screening. The actual cost, detection rate and cost-effectiveness ratio were calculated. The Markov simulation model was constructed based on the natural history of breast cancer with TreeAge Pro2011. The model was running over thirty years (each cycle represents one year). Combined with the data from previous project and publish literature, Markov cohort simulation was used to estimate the life years (LYs) and quality adjusted life years (QALYs) by summing across those cycles. The sensitivity analysis was performed for incidence of breast cancer, health state utility and discount rate.ResultsThe A group involved26224females while the B group involved24282. The detection rate of breast cancer (1/10million) was91.54and28.86. The percentage of early stage breast cancer was45.83%and28.57%, respectively. The highest detection rate was found in women aged from45to65.In order to detection one case of breast cancer, the number needed to invite for screening (NNI) and number needed to be screened (NNBS) for screening program were1595and1308. Cost-effectiveness analysis was6152.37yuan per detection rate of breast cancer (1/10million). During the following30years, comparing with the normal screening, the tertiary breast cancer screening and diagnosis system for100thousand women will reduce57cases of breast cancer, and save872.00LYs,965.91QALYs. With the discount rate of3%, Cost-utility analysis was16175.79yuan per life year saved,14603.11yuan per QALY saved. One-way sensitivity analysis showed that parameters had no significant effect on the model. ConclusionsMarkov model is recommended to conduct health economic evaluation for screening projects. Compared to control group, the screening strategy of intervention group improved both the detection rate of breast cancer and the percentage of early stage breast cancer. The tertiary breast cancer screening and diagnosis system is a preferable option for breast cancer screening.