Quality assurance target for the performance of Community-based Breast Cancer Screening in China-a model simulation
Objective Local governments have sponsored community based breast cancer screening programs in several urban cities despite the doubt about the role of clinical breast examination for early detection in the diverse Chinese population.In Tianjin, the fourth largest city in terms of urban population in China, the breast cancer screening starts at Community Health Centers (CHCs) where no mammography and ultrasound service are provided.A decision-analytic model was used in current study to predict the feasibility of community-based breast cancer screening strategy.A sensitivity analysis approach will be used to identify the relevant factors which have significant influence the feasibility of the breast cancer screening practice in Community Health Centers and optimum control ranges was tested in addition.Method A state-transition Markov model was developed consisted of two linked modules: (a) breast cancer progress model, (b) screening model.Model primary outcomes was the incremental cost-effectiveness ratio (ICER) which is the program”s cost per quality adjusted life year (QALY) gained to evaluate its effectiveness.A Monte-Carlo simulation was done with 1000 runs to select values at random from appropriate probabilistic distributions model parameters.Results Compared with no screening, the community-based breast cancer screening would save between 1583 discounted quality-adjusted life years per 100,000 women screened.The probability of the ICER being below ￥ 139 593 (3 GDP) per QALY saved was 100% for all three non-dominated options.Only when attendant rate input value was greater than 50%, the probability for annual screening strategy being cost effective was greater than 95% at the 3 GDP level of WTE The probability for annual screening strategy being cost effective was greater than 95% at the 2 GDP level of WTP only when compliance rate for transfer was set greater than 80%.When 20% Stage I tumor was detected on the screening simulation, the probability for annual screening strategy being cost effective was greater than 95% until WTP was being greater than 2 GDP level.Conclusion Annually community-based breast cancer screening was cost effective given WTP at 3 GDP based on the breast cancer incidence in urban area.Key measures are highly needed for quality control on performance indicators to ensure the cost effectiveness of breast cancer screening.
breast cancer screening cost effectiveness
Lan Yang Yuan Wang Wen Li Jing Wang Qixian Yu Xin Wen Lanjun Ding Juan Cheng Geertruida H.De Bock Wenli Lu
Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical Universit Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical Universit Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical Universit Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.
国内会议
天津
英文
227-241
2016-07-26（万方平台首次上网日期，不代表论文的发表时间）