Cost-Effectiveness Analysis of a Screening Program for Breast Cancer in Vietnam

Lan Hoang Nguyen; Wongsa Laohasiriwong; John Frederick Stewart; Pamela Wright; Yen Thi Bach Nguyen; Peter C Coyte

doi:10.1016/j.vhri.2013.02.004

Cost-Effectiveness Analysis of a Screening Program for Breast Cancer in Vietnam

Value Health Reg Issues. 2013 May;2(1):21-28. doi: 10.1016/j.vhri.2013.02.004. Epub 2013 Apr 30.

Authors

Lan Hoang Nguyen¹, Wongsa Laohasiriwong², John Frederick Stewart³, Pamela Wright⁴, Yen Thi Bach Nguyen⁵, Peter C Coyte⁶

Affiliations

¹ PhD Program in Public Health, Graduate School, Khon Kaen University, Khon Kaen, Thailand; Hue College of Medicine and Pharmacy, Hue University, Hue City, Vietnam.
² Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand. Electronic address: drwongsa@gmail.com.
³ Department of Economics, University of North Carolina, Chapel Hill, USA.
⁴ Medical Committee Netherlands-Vietnam, Amsterdam, Netherlands.
⁵ Institute for Preventative Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
⁶ Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 29702847
DOI: 10.1016/j.vhri.2013.02.004

Abstract

Objective: This study aimed to evaluate the cost-effectiveness of a screening program for breast cancer from the health care payers' perspective.

Methods: A Markov model was used to compare costs and effects of an annual screening program using clinical breast examination (CBE) with the absence of screening on a cohort of 4,103,285 asymptomatic women aged 40 years. The model was analyzed over the cohort's lifetime under the assumption that women participated in the screening program annually for 15 years. The model integrated both epidemiological and cost data for breast cancer from prior Vietnamese studies. Costs were measured in 2008 US dollars. Costs and effects were discounted annually at 3%. The incremental cost-effectiveness ratio (ICER) was defined as the difference in cost per life-years saved (LYS). One-way and probabilistic sensitivity analyses were implemented to assess the uncertainty of inputs.

Results: The ICER for the breast cancer screening program with CBE was US $994.96 per LYS compared with the absence of screening. Earlier initiation of the program at age 35 years increased the ICER to US $1196.68 per LYS, while extending the duration of time screened to age 60 years decreased the ICER. Changing the participation rate to 70%, reducing the specificity of CBE testing, and increasing the cost of the screening program by 30% raised ICER estimates to US $1419.32, US $1124.15, and US $1292.03 per LYS, respectively.

Conclusion: Breast cancer screening with CBE for women aged 40 to 55 years is considered very cost-effective in Vietnam according to the World Health Organization criteria.

Keywords: Vietnam; breast cancer; clinical breast examination; cost-effectiveness; screening program.