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.
