Cost-effective Of Community-based Breast Cancer Screening

Objective: Breast cancer screening as a secondary prevention is an important method which can find, diagnose and treat breast cancers early. Breast cancer screening is generally accepted as one of the most effective control measures for malignant tumor, which can improve the patient's survival and reduce mortality.Breast cancer screening as a public health service content of the project in Tianjin, it works by community doctors for 35-69 ages married local women who were the permanent residence. To study the estimate and control of the cost of community-based breast cancer screening, and then combined with the screening effect to have a comprehensive evaluation, evaluating the effect of different screening strategies which compare with no-screened people such as the change of the Quality-adjusted life years. By cost-effect(utility) analysis for different screening strategies to explore the best scheme with the limited resources and making suited scheme for our government.Methods: Information was collected from literature and interview of doctors who involved in breast cancer screening program. Evaluating the unit cost of different screening methods for breast cancer and combining Tianjin population who are 35 to69 old years in 2013 to estimate unit project management costs. They were as the parameters and applied to the Markov-decision model. We preformed for a single simulated cohort of 100 000 healthy women aged 35 years old during the next 50 years in different screening strategy. Model outcomes were life expectancy,quality-adjusted life expectancy, and lifetime costs. Comparative performance of the remaining screening strategies was measured by using the incremental cost-effectiveness ratio(ICER). We conducted a probabilistic sensitivity analysis,which involved specifying appropriate probabilistic distributions for clinical parameters and employing a Monte-Carlo simulation with 1000 runs to construct cost-effectiveness acceptability curves to present the uncertainty in the ICER cased by sampling variation.Results:(1) Combination the population statistics in 2013 in Tianjin, the unit cost of different screen method such as clinical breast examination, molybdenum target,Mammography, B ultrasonic examination and pathological examination were 3.54,60.58, 13.13 and 140.79 Yuan, the changes in range were 2.26 ~ 5.10, 41.90 ~ 105.51,7.53 ~ 19.25 and 98.75 ~ 236.63 Yuan. The unit cost of project management was 29.8Yuan. Based-on the Markov model, we preformed for a single simulated cohort of100 000 healthy women aged 35 years old during the next 50 years in different screening strategy. The Quality-adjusted life years is 2 388 195, cost is RMB 661.56 million Yuan for no screening population. Comparing with no screening group, the ICER were 53 032, 50 917, 48 722 Yuan for the screening strategy of once a year,once every two years, once every three years.Conclusion: A threshold of below three times of its GDP per capita per QALY has been recommended by the World Health Organization(WHO) for developing country, three screening strategies are cost effective. According to the standards of three times of its GDP per capita per QALYs, once a year of screening strategy works best for the health economics evaluation. We recommend the priority once a year of screening. As long as ensuring the attendance rate and compliance rate are higher than50%, the sensitivity of clinical breast examination(CBE) is higher than 0.2 for a progressed breast cancer screening, it can ensure the cost effectiveness of screening strategy(that is, compared to no screening strategy, choice of screening strategies possibility is higher than 95%). However as the breast cancer screening services for community health service agencies, we need to take the community human resources in consideration. For example, it needs to provide 237 doctors for breast cancer screening in Tianjin, there are 209 doctors worked in clinical breast examination.