Cost-effectiveness analysis of breast cancer control interventions in Peru

Sten G. Zelle, Tatiana Vidaurre, Julio E. Abugattas, Javier E. Manrique, Gustavo Sarria, José Jeronimo, Janice N. Seinfeld, Jeremy A. Lauer, Cecilia R. Sepulveda, Diego Venegas, Rob Baltussen

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22 Citations (Scopus)

Abstract

Objectives: In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the costeffectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods: We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results: The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions: Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.

Original languageEnglish
Article numbere82575
Pages (from-to)1-17
Number of pages17
JournalPLoS ONE
Volume8
Issue number12
DOIs
Publication statusPublished - 10 Dec 2013

Keywords

  • trastuzumab
  • breast cancer
  • cancer control
  • cancer palliative therapy
  • cancer screening
  • cancer therapy
  • cost effectiveness analysis
  • disability adjusted life year
  • health care cost
  • mammography
  • breast neoplasms

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    Zelle, S. G., Vidaurre, T., Abugattas, J. E., Manrique, J. E., Sarria, G., Jeronimo, J., Seinfeld, J. N., Lauer, J. A., Sepulveda, C. R., Venegas, D., & Baltussen, R. (2013). Cost-effectiveness analysis of breast cancer control interventions in Peru. PLoS ONE, 8(12), 1-17. [e82575]. https://doi.org/10.1371/journal.pone.0082575