Abstract P6-02-09: Bahcesehir mammography screening project (BMSP) is cost-effective in a developing country
Authors: Ozmen V , Cabiogsu N , Ozkan-Gurdal S , Ozaydin N , Kayhan A , Aribal E 
Published: May 2016

Objective: This study aims to determine the cost-effectiveness of a population-based organized mammography screening in a developing country (Bahcesehir, Istanbul, Turkey).

Material and methods: Between 2009 and 2015, mammographies were obtained by 2-year intervals for women with ages 40-69 years (n=7167), living in Bahcesehir.. Cost for BMSP included salaries paid for the staff, purchase and maintenance of diagnostic devices, and cost of diagnosis, treatment and follow-up of detected breast cancer patients. The incremental cost-effectiveness ratio (ICER) was calculated as the extra expense per extra "life year" saved by BMSP, when compared to breast cancer detected without screening (BCWS). ICER=CostBMSP-CostBCWS/Life-yearsBMSP – Life-yearsBCWS.Gross Domestic Product per capita in Turkey in 2014 was found (10.650 USD). According to WHO, ICER value below GDP per capita is defined cost-effective.

Results

Of 7167 women, 67 were diagnosed with breast cancer after the third screening round. Stages of BC patients diagnosed in BMSP and national breast cancer registry program (NBRP), expected 5 year survival rates and expected median survival life according to stages, and stage distribution of patients were shown in Table 1.

Table 1StagesExpected 5-year Survival RateExpected Median Life (years)Workload Loss (months)National Breast Cancer Registry ProgramBahcesehir Mammography Screening ProgramDifferencesStage 093%25.8924.919.414.5Stage 188%25.89626.650.724.1Stage 277.5%13.60644.920.9-24Stage 358%6.36920.87.5-13.3Satge 415%1.83122.81.5-1.3Medain Expected Life time (years)   15.6321.55.87Total expected Life Time (years)   1047.431440.59393.16Average Woke Loss (months)   6.65.54-1.06Total Work Loss (months)   441.93371-70.93

Median expected life time of patients in screening group was 5.87 years longer than patients in NBRP (21.50 years vs 15.63 years), and, totally 393 years were saved with BMSP. Additionally, 71 months of workload were saved with mammography screening (Table 2).

Table 2Cost Analysis of Breast Cancer PatientsNational Breast Cancer Registry Program (without screening)Bahcesehir Mammography Screening ProgramDifferenceNational Screening by Social Security Institute (SSI)Difference (SSI-NBRP)Cost of population-based screening0937.500 USD937.500 USD609.296 USD609.296 USDCost of diagnosis, treatment and follow-up858.053 USD696.114 USD-167.939 USD696.114 USD-161.939 USDWorkload losst185.832 USD161.006 USD-29.827 USD166.006 USD-29.287 USDTotal cost1.043.885 USD1.794.620 USD745.734 USD1.471.416 USD418.070 USDTotal expected life time (years)1047.431440.59393.161440.59393.16Incremental loss effectiveness ratio (ICER)  1.8971.0141.062

The incremental cost-effectiveness ratio (ICER) was found 1.897 USD/year. Since ICER/year has been calculated to be less than PDG per capita (10.650 USD), BMSP definitely seems to be cost-effective.

Conclusion

Population-based mammography screening results in early detection of breast cancer, and seems to be cost-effective in Bahçesehir Mammography Screening Program in Turkey. Our findings also suggest that a nation wide organized population- based screening paid by National Social Security Institute in Turkey might be more cost-effective than BMSP.

Citation Format: Ozmen V, Cabiogsu N, Ozkan-Gurdal S, Ozaydin N, Kayhan A, Aribal E. Bahcesehir mammography screening project (BMSP) is cost-effective in a developing country. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-02-09.