Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data
Background/Purpose: We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. Methods: We interlinked four national databases- Cancer Registry, Mortality Registry, National Heal...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S092966462100293X |
| _version_ | 1818986579677413376 |
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| author | Chia-Ni Lin Kuo-Ting Lee Sheng-Mao Chang Jung-Der Wang |
| author_facet | Chia-Ni Lin Kuo-Ting Lee Sheng-Mao Chang Jung-Der Wang |
| author_sort | Chia-Ni Lin |
| collection | DOAJ |
| description | Background/Purpose: We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. Methods: We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002–2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. Results: The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. Conclusion: Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted. |
| first_indexed | 2024-12-20T18:53:02Z |
| format | Article |
| id | doaj.art-2d51daf2ad1a40c88db97fa50cc586c6 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-20T18:53:02Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-2d51daf2ad1a40c88db97fa50cc586c62022-12-21T19:29:34ZengElsevierJournal of the Formosan Medical Association0929-66462022-03-011213633642Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world dataChia-Ni Lin0Kuo-Ting Lee1Sheng-Mao Chang2Jung-Der Wang3Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Surgery, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Statistics, National Cheng Kung University, Tainan, TaiwanDepartment of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Corresponding author. Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan. Fax: +886 6 2359033.Background/Purpose: We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. Methods: We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002–2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. Results: The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. Conclusion: Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.http://www.sciencedirect.com/science/article/pii/S092966462100293XBreast neoplasmsSurvivalHealth expendituresLife expectancyLoss-of-life expectancy |
| spellingShingle | Chia-Ni Lin Kuo-Ting Lee Sheng-Mao Chang Jung-Der Wang Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data Journal of the Formosan Medical Association Breast neoplasms Survival Health expenditures Life expectancy Loss-of-life expectancy |
| title | Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data |
| title_full | Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data |
| title_fullStr | Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data |
| title_full_unstemmed | Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data |
| title_short | Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data |
| title_sort | cost effectiveness evaluation of mammography screening program in taiwan adjusting different distributions of age and calendar year for real world data |
| topic | Breast neoplasms Survival Health expenditures Life expectancy Loss-of-life expectancy |
| url | http://www.sciencedirect.com/science/article/pii/S092966462100293X |
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