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Development of Benefit Package of Breast Cancer Screening with Mammography and Ultrasound in High Risk Women in Thailand

วรรณฤดี อิสรานุวัฒน์ชัย; Wanrudee Isaranuwatchai; ณัฏฐิญา ค้าผล; Nattiya Kapol; ธัญญรัตน์ อโนทัยสินทวี; Thunyarat Anothaisintawee; ศิวนัย ดีทองคํา; Siwanai Deethongkum; ฉัฐญาณ์ วงศ์รัฐนันท์; Chathaya Wongrathanandha; ธวัชสภณ ธรรมบํารุง; Tawasapon Thambamroong; กุมารี พัชนี; Kumaree Pachanee;
Date: 2567-07
Abstract
Breast cancer is the leading cause of death among all cancers for female, and its prevalence is increasing every year.The survival rate of patients depends on the stage at which the cancer is detected. Screening for breast cancer at an early stage so that the disease can be treated can therefore improve the patient's chances of survival. Breast cancer screening with mammograms and ultrasounds has been studied for its effectiveness in early detection which can subsequently lower the mortality rate.Thailand has not included mammogram and ultrasound for breast cancer screening in the National Health Security system's benefits given that previous research on the cost-utility of breast cancer screening with mammogram in the general Thai women reported that this screening was not cost- effective. Building on the previous work, focusing only on the high-risk women especially given the limited numbers of mammograms has potential to be more cost-effective and feasible than screening for all Thai women. Breast cancer screening in high- risk women is becoming more popular around the world. To predict the risk of developing breast cancer, various risk prediction models were developed by taking into account the major risk factors for breast cancer. In Thailand, a model was developed to predict the risk of breast cancer in Thai women, and it had a moderate ability to differentiate between women with and without breast cancer. Studies have found that screening for breast cancer in high-risk women with mammograms could be cost-effective than not screening in high-risk women. Therefore, this study aims to: 1) conduct a cost-utility analysis of mammogram and ultrasound screening for breast cancer in high-risk women; 2) to assess the budget impact of mammogram and ultrasound screening for breast cancer in highrisk groups, and 3) to investigate the feasibility of incorporating mammography and ultrasound screening for high- risk populations into the Universal Health Coverage Scheme’ s benefit package. This study was a cost-utility analysis using Markov modeling to compare the costs and outcomes of using a risk assessment tool to screen and identify women aged 40-70 who are at high risk for breast cancer which will be followed by a mammogram and ultrasound, compared to opportunistic screening for breast cancer with mammograms and ultrasound. Furthermore, this study examined the budget impact on the universal health coverage scheme for the next five years if mammogram and ultrasound screening for breast cancer in high-risk groups were included in the benefit package, as well as the practical feasibility of this measure. The study showed that using the risk assessment tool with a score of 1. 15 to identify those at high risk and screening by mammogram and ultrasound every 1 year, 2 years, and 3 years was not cost-effective in the Thai context when compared to an opportunistic breast cancer screening by mammogram and ultrasound. The incremental cost-effectiveness ratio was 6,417,403 Baht/QALY. For the 5-year budget impact, using the risk assessment tool prior mammogram and ultrasound every 1-3 years increases the budget by 10,574, 7,158 and 5,459 million Baht, respectively. The sensitivity analysis revealed that the three most sensitive factors were the risk assessment tool's sensitivity, the probability of disease-free survival to recurrence breast cancer, and the cost of mammogram and ultrasound breast cancer screening. As a result, proposed policy recommendations are: 1. The study data is used according to the context and the screening test proposed in 2021, this type of screening will not be economically worthwhile. And it may not be possible to actually put it into practice or the chance of it being practical will be very small based on the number of mammogram machines that are available. 2. Additional studies should be conducted to develop a screening test for breast cancer risk in Thai women. Factors including family history and/or genetics that are related to current breast cancer should be included.
Copyright ผลงานวิชาการเหล่านี้เป็นลิขสิทธิ์ของสถาบันวิจัยระบบสาธารณสุข หากมีการนำไปใช้อ้างอิง โปรดอ้างถึงสถาบันวิจัยระบบสาธารณสุข ในฐานะเจ้าของลิขสิทธิ์ตามพระราชบัญญัติสงวนลิขสิทธิ์สำหรับการนำงานวิจัยไปใช้ประโยชน์ในเชิงพาณิชย์
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