Cost-effectiveness analysis of breast cancer screening using mammography in singapore: A modeling study

Sarocha Chootipongchaivat*, Xin Yi Wong, Kevin Ten Haaf, Mikael Hartman, Kelvin B. Tan, Nicolien T. Van Ravesteyn, Hwee Lin Wee

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

Abstract

Background: Limited research is available on the costeffectiveness of breast cancer screening programs in Asian countries. We evaluated the cost-effectiveness of Singapore's national mammography screening program, implemented in 2002, recommending annual screening between ages 40 and 49 and biennial screening between ages 50 and 69, and alternative screening scenarios taking into account important countryspecific factors. Methods: We used national data from Singapore in the MIcrosimulation SCreening ANalysis-Fatal diameter (MISCAN-Fadia) model to simulate 302 screening scenarios for 10 million women born between 1910 and 1969. Screening scenarios varied by starting and ending age, screening interval, and attendance. Outcome measures included life-years gained (LYG), breast cancer deaths averted, false positives, overdiagnosis, qualityadjusted life years (QALY), costs (in 2002 Singapore dollars; S$), and incremental cost-effectiveness ratios (ICER). Costs and effects were calculated and discounted with 3% using a health care provider's perspective. Results: Singapore's current screening program at observed attendance levels required 54,158 mammograms per 100,000 women, yielded 1,054 LYG, and averted 57 breast cancer deaths. At attendance rates ≥50%, the current program was near the efficiency frontier. Most scenarios on the efficiency frontier started screening at age 40. The ICERs of the scenarios on the efficiency frontiers ranged between S$10,186 and S$56,306/QALY, which is considered cost-effective at a willingness-to-pay threshold of S$70,000/QALY gained. Conclusions: Singapore's current screening program lies near the efficiency frontier, and starting screening at age 40 or 45 is costeffective. Furthermore, enhancing screening attendance rates would increase benefits while maintaining cost-effectiveness. Impact: Screening all women at age 40 or 45 is cost-efficient in Singapore, and a policy change may be considered.

Original languageEnglish
Pages (from-to)653-660
Number of pages8
JournalCancer Epidemiology Biomarkers and Prevention
Volume30
Issue number4
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Funding Information:
We thank the staff at the National Registry of Disease Office (Singapore) and BreastScreen Singapore for granting access to the datasets, the Breast Cancer Prevention Programme for providing expert opinion and localized data, and the Saw Swee Hock School of Public Health for granting access to the NUH PASS database. Finally, we thank A/P Joanne Ngeow for providing valuable comments on this study. This publication was made possible by the Singapore Ministry of Health, Health Services Research Competitive Research Grant, administered by the National Medical Research Council (grant number HSRG/13MAY006). Support was also provided from the NCI as part of the Cancer Intervention and Surveillance Modeling Network (CISNET), which supported the underlying development of the simulation model utilized (grant number U01 CA199218). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. M. Hartman was supported by the National Medical Research Council Clinician Scientist Award (Senior Investigator Category, NMRC/CSA-SI/0015/2017), the National University Cancer Institute Singapore Centre Grant Programme (CGAug16M005), the Saw Swee Hock School of Public Health Programme of Research Seed Funding (SSHSPHRes-Prog), and the Asian Breast Cancer Research Fund (N-176-000-023-091).

Funding Information:
We thank the staff at the National Registry of Disease Office (Singapore) and BreastScreen Singapore for granting access to the datasets, the Breast Cancer Prevention Programme for providing expert opinion and localized data, and the Saw Swee Hock School of Public Health for granting access to the NUH PASS database. Finally, we thank A/P Joanne Ngeow for providing valuable comments on this study. This publication was made possible by the Singapore Ministry of Health, Health Services Research Competitive Research Grant, administered by the National Medical Research Council (grant number HSRG/13MAY006). Support was also provided from the NCI as part of the Cancer Intervention and Surveillance Modeling Network (CISNET), which supported the underlying development of the simulation model utilized (grant number U01 CA199218). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. M. Hartman was supported by the National Medical Research Council Clinician Scientist Award (Senior Investigator Category, NMRC/CSA-SI/0015/2017), the National University Cancer Institute Singapore Centre Grant Programme (CGAug16M005), the Saw Swee Hock School of Public Health Programme of Research Seed Funding (SSHSPHRes-Prog), and the Asian Breast Cancer Research Fund (N-176-000–023-091).

Funding Information:
S. Chootipongchaivat reports grants from Singapore Ministry of Health, Health Services Research Competitive Research Grant, administered by the National Medical Research Council, and grants from NIH/NCI during the conduct of the study. K. ten Haaf reports grants from Singapore Ministry of Health, Health Services Research Competitive Research Grant, administered by the National Medical Research Council, during the conduct of the study, as well as grants from European Union (Horizon 2020), grants from University of Zurich, Switzerland, nonfinancial support from International Association for the Study of Lung Cancer, grants from Cancer Research UK, nonfinancial support from Russian Society of Clinical Oncology, nonfinancial support and other from BIOMEDICAL RESEARCH IN ENDSTAGE AND OBSTRUCTIVE LUNG DISEASE HANNOVER (BREATH), and grants from NIH/NCI outside the submitted work. N.T. van Ravesteyn reports grants from Singapore Ministry of Health and NIH/NCI during the conduct of the study. No disclosures were reported by the other authors.

Publisher Copyright:
© 2021 American Association for Cancer Research.

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