Telemammography for breast cancer screening: a cost-effective approach in Argentina.
BMJ health informatics
COVID-19
health equity
information systems
public health
Journal
BMJ health & care informatics
ISSN: 2632-1009
Titre abrégé: BMJ Health Care Inform
Pays: England
ID NLM: 101745500
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
01
03
2021
accepted:
22
06
2021
entrez:
20
7
2021
pubmed:
21
7
2021
medline:
31
7
2021
Statut:
ppublish
Résumé
Argentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country's Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare. A cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results. It was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations. Tele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic. There is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.
Identifiants
pubmed: 34281995
pii: bmjhci-2021-100351
doi: 10.1136/bmjhci-2021-100351
pmc: PMC8290945
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Bull World Health Organ. 2016 Dec 1;94(12):925-930
pubmed: 27994285
J Med Screen. 2014 Dec;21(4):180-8
pubmed: 25186116
Ann Oncol. 2020 Aug;31(8):1065-1074
pubmed: 32442581
Ann Oncol. 2008 Apr;19(4):614-22
pubmed: 18024988
J Glob Oncol. 2018 Aug;4:1-25
pubmed: 30156947
Rev Panam Salud Publica. 2019 Jul 31;43:e63
pubmed: 31410087
Salud Publica Mex. 2009;51 Suppl 2:s286-95
pubmed: 19967284
Rev Panam Salud Publica. 2006 Aug-Sep;20(2-3):113-24
pubmed: 17199906
Telemed J E Health. 2002 Fall;8(3):281-91
pubmed: 12419022
Cureus. 2018 Apr 8;10(4):e2448
pubmed: 29888152
Br J Med Med Res. 2014 May 1;4(13):2599-2610
pubmed: 25984460
Med J Islam Repub Iran. 2017 Dec 20;31:113
pubmed: 29951414
Breast J. 2006 Jan-Feb;12 Suppl 1:S81-90
pubmed: 16430401