Costs, effects and cost-effectiveness of breast cancer control in Ghana.
OBJECTIVE
Breast cancer control in Ghana is characterised by low awareness, late-stage treatment and poor survival. In settings with severely constrained health resources, there is a need to spend money wisely. To achieve this and to guide policy makers in their selection of interventions, this study systematically compares costs and effects of breast cancer control interventions in Ghana.


METHODS
We used a mathematical model to estimate costs and health effects of breast cancer interventions in Ghana from the healthcare perspective. Analyses were based on the WHO-CHOICE method, with health effects expressed in disability-adjusted life years (DALYs), costs in 2009 US dollars (US$) and cost-effectiveness ratios (CERs) in US$ per DALY averted. Analyses were based on local demographic, epidemiological and economic data, to the extent these data were available.


RESULTS
Biennial screening by clinical breast examination (CBE) of women aged 40-69 years, in combination with treatment of all stages, seems the most cost-effective intervention (costing $1299 per DALY averted). The intervention is also economically attractive according to international standards on cost-effectiveness. Mass media awareness raising (MAR) is the second best option (costing $1364 per DALY averted). Mammography screening of women of aged 40-69 years (costing $12,908 per DALY averted) cannot be considered cost-effective.


CONCLUSIONS
Both CBE screening and MAR seem economically attractive interventions. Given the uncertainty about the effectiveness of these interventions, only their phased introduction, carefully monitored and evaluated, is warranted. Moreover, their implementation is only meaningful if the capacity of basic cancer diagnostic, referral and treatment and possibly palliative services is simultaneously improved.
Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. s.zelle@elg.umcn.nl
Sten G
SG
Zelle
Kofi M
KM
Nyarko
William K
WK
Bosu
Moses
M
Aikins
Laurens M
LM
Niëns
Jeremy A
JA
Lauer
Cecilia R
CR
Sepulveda
Jan A C
JA
Hontelez
Rob
R
Baltussen
D000328:Adult; D000368:Aged; D001364:Awareness; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006266:Health Education / Q000379:methods; D006801:Humans; D008327:Mammography / Q000191:economics; D008402:Mass Media; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D010166:Palliative Care / Q000191:economics; D012959:Socioeconomic Factors