Telemammography for breast cancer screening: a cost-effective approach in Argentina

BMJ Health Care Inform. 2021 Jul;28(1):e100351. doi: 10.1136/bmjhci-2021-100351.

Abstract

Objectives: Argentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country's Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.

Methods: A cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.

Results: It was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.

Discussion: Tele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.

Conclusion: There is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

Keywords: BMJ health informatics; COVID-19; health equity; information systems; public health.

MeSH terms

  • Adult
  • Argentina
  • Breast Neoplasms* / diagnosis
  • Breast Neoplasms* / economics
  • COVID-19
  • Cost-Benefit Analysis / economics*
  • Early Detection of Cancer / economics*
  • Female
  • Health Services Accessibility
  • Humans
  • Mammography / economics*
  • Medical Informatics*
  • Middle Aged
  • Quality-Adjusted Life Years
  • Telemedicine*
  • Vulnerable Populations