Breast Cancer Screening in Georgia: Choosing the Most Optimal and Cost-Effective Strategy.

Autor: Irzaldy A; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: a.irzaldy@erasmusmc.nl., Gvamichava R; Georgian Society of Clinical Oncology, Tbilisi, Georgia., Beruchashvili T; Georgian Society of Clinical Oncology, Tbilisi, Georgia., Sturua L; Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia., van Ravesteyn NT; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., de Koning HJ; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Heijnsdijk EAM; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Value in health regional issues [Value Health Reg Issues] 2024 Jan; Vol. 39, pp. 66-73. Date of Electronic Publication: 2023 Nov 22.
DOI: 10.1016/j.vhri.2023.09.002
Abstrakt: Objectives: To define the optimal and cost-effective breast cancer screening strategy for Georgia.
Methods: We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses.
Results: Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (€16 218/QALY), well above the willingness-to-pay threshold of €12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of €12 507.
Conclusions: Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.
Competing Interests: Author Disclosures Links to the individual disclosure forms provided by the authors are available here.
(Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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