Please use this identifier to cite or link to this item: https://doi.org/10.1158/1055-9965.EPI-20-1230
Title: Cost-effectiveness Analysis of Breast Cancer Screening Using Mammography in Singapore: A Modeling Study
Authors: Chootipongchaivat, Sarocha
Wong, Xin Yi
Haaf, Kevin Ten
Hartman, Mikael 
Tan, Kelvin B
van Ravesteyn, Nicolien T
Wee, Hwee-Lin 
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Public, Environmental & Occupational Health
PROGRAM
PARTICIPATION
MORTALITY
BARRIERS
Issue Date: 1-Apr-2021
Publisher: AMER ASSOC CANCER RESEARCH
Citation: Chootipongchaivat, Sarocha, Wong, Xin Yi, Haaf, Kevin Ten, Hartman, Mikael, Tan, Kelvin B, van Ravesteyn, Nicolien T, Wee, Hwee-Lin (2021-04-01). Cost-effectiveness Analysis of Breast Cancer Screening Using Mammography in Singapore: A Modeling Study. CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION 30 (4) : 653-660. ScholarBank@NUS Repository. https://doi.org/10.1158/1055-9965.EPI-20-1230
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.
Source Title: CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
URI: https://scholarbank.nus.edu.sg/handle/10635/208336
ISSN: 10559965
15387755
DOI: 10.1158/1055-9965.EPI-20-1230
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