Cost-effectiveness Analysis of Breast Cancer Screening Using Mammography in Singapore: A Modeling Study
Open Access
- 2 February 2021
- journal article
- research article
- Published by American Association for Cancer Research (AACR) in Cancer Epidemiology, Biomarkers & Prevention
- Vol. 30 (4), 653-660
- https://doi.org/10.1158/1055-9965.EPI-20-1230
Abstract
Background: Limited research is available on the cost-effectiveness 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 country-specific factors. Methods: We used national data from Singapore in the MIcro-simulation 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.Funding Information
- National Medical Research Council (HSRG/13MAY006)
- Cancer Intervention and Surveillance Modeling Network (U01 CA199218)
- National Medical Research Council (NMRC/CSA-SI/0015/2017)
- National University Cancer Institute, Singapore (CGAug16M005)
- Asian Breast Cancer Research Fund (N-176-000-023-091)
This publication has 27 references indexed in Scilit:
- National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicatorsJournal of Medical Screening, 2015
- At what age should screening mammography be recommended for Asian women?Cancer Medicine, 2015
- Is Mammography for Breast Cancer Screening Cost-Effective in Both Western and Asian Countries?: Results of a Systematic ReviewAsian Pacific Journal of Cancer Prevention, 2013
- Prediction of higher mortality reduction for the UK Breast Screening Frequency Trial: a model-based approach on screening intervalsBritish Journal of Cancer, 2011
- Risk factors for breast cancer in East Asian women relative to women in the WestAsia-Pacific Journal of Clinical Oncology, 2009
- European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition—summary documentAnnals of Oncology, 2008
- Health Limitations and Quality of Life Associated With Cancer and Other Chronic Diseases by Phase of CareMedical Care, 2007
- Pattern of participation in a cohort aged 50–60 years at first invitation to the service-screening programme with mammography in Stockholm county, SwedenPreventive Medicine, 2005
- Effect of Screening and Adjuvant Therapy on Mortality from Breast CancerThe New England Journal of Medicine, 2005
- The impact of a breast cancer screening programme on quality‐adjusted life‐yearsInternational Journal of Cancer, 1991