RT Journal Article
SR Electronic
T1 Telemammography for breast cancer screening: a cost-effective approach in Argentina
JF BMJ Health & Care Informatics
JO BMJ Health Care Inform
FD BMJ Publishing Group Ltd
SP e100351
DO 10.1136/bmjhci-2021-100351
VO 28
IS 1
A1 Victoria Alba Malek Pascha
A1 Li Sun
A1 Ramiro Gilardino
A1 Rosa Legood
YR 2021
UL http://informatics.bmj.com/content/28/1/e100351.abstract
AB 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.Data are available in a public, open-access repository. All data and links relevant to the study are included in the article (table 1) or uploaded as supplementary information.