Cost-effectiveness of breast cancer screening programme for women in rural China
Cost-effectiveness of breast cancer screening programme for women in rural China
复制标题
中国农村妇女乳腺癌筛查项目的成本效益
DOI：
10.1002/ijc.31956
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发表时间：
2019-05-15
影响因子：
6.4
通讯作者：
Legood, Rosa
中科院分区：
文献类型：
--
作者：
Sun, Li;Sadique, Zia;Legood, Rosa
在低收入和中等收入国家中，乳腺癌筛查的较昂贵，较便宜的替代选择是将超声检查用作主要筛查测试。 2009年，中国为35-64岁的农村妇女启动了一项乳腺癌筛查计划，临床乳房检查以及超声波作为主要工具。我们的研究旨在分析乳房筛查的成本效益，而中国农村妇女没有筛查。我们开发了一个马尔可夫模型，以估计从社会角度来看35岁的农村妇女的终身成本和影响。干预部门的无症状女性在64岁之前每3年进行一次筛查。非筛查臂中的乳腺癌只能在症状出现时诊断。使用单向和概率敏感性分析探索了参数不确定性。与没有筛查相比，乳腺癌筛查的成本增加了186.7美元，导致质量调整后的寿命（Qalys）损失。乳房筛查更为昂贵，对$ -916/QALY的成本效益比（ICER）的农村妇女造成了损害。灵敏度分析确定了误报的效用损失是最大程度地影响结果的因素，但这并不影响结论。在乳腺癌发病率如此低的农村环境中，对于当前的筛查工具，无症状疾病的筛查并不具有成本效益。应给予优先级，以确保有症状的妇女在早期阶段有适当的诊断和治疗，因为这将导致死亡率降低而不会造成通常的筛查危害。
In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35-64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost-effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality-adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.