Cost-effectiveness of breast cancer control strategies in Central America: the cases of Costa Rica and Mexico.
This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50-70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40-70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible socioeconomic barriers.
Institute for Medical Technology Assessment and Institute for Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Laurens M
LM
Niëns
Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Sten G
SG
Zelle
Instituto Mexicano del Seguro Social (IMSS), México DF, México.
Cristina
C
Gutiérrez-Delgado
Unidad de Análisis Económico, Secretaria de Salud, México D.F., México.
Gustavo
G
Rivera Peña
Pharmaco-economics department Caja Costarricense de Seguro Social, San José, Costa Rica.
Blanca Rosa
BR
Hidalgo Balarezo
Ministerio de Salud, San José, Costa Rica.
Erick
E
Rodriguez Steller
Institute for Medical Technology Assessment and Institute for Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Frans F H
FF
Rutten
D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003364:Costa Rica; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033181:Information Dissemination; D008327:Mammography / Q000191:economics; D008800:Mexico; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D000068878:Trastuzumab
D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab