ObjectivesIn Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. MethodsWe performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted.ResultsThe current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. ConclusionsOur analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this intervention is only meaningful if awareness raising, diagnostic, referral, treatment and basic palliative services are simultaneously improved, and if financial and organizational barriers to these services are reduced.
Objetivo: Analizar las tendencias de mortalidad por cáncer gástrico en Perú de 1995 a 2013 y sus diferencias por sexo, grupos etarios, regiones políticas y geográficas. Métodos: Estudio ecológico de series de tiempo basado en 49 690 registros de defunción del Ministerio de Salud, de 1995 a 2013; se calcularon tasas de mortalidad brutas, específicas y estandarizadas por año; según sexo, grupo de edad, regiones política y geográfica, para analizar tendencias estimando joinpoints y cambios de porcentaje anual (CPA) mediante modelos de regresión segmentada utilizando el software Joinpoint Regression Desktop versión 4.5.0.0. Resultados: La tendencia de la tasa de mortalidad estandarizada (TME) por cáncer gástrico en Perú fue decreciente (16,1 x 100 000 hab. en 1995 a 11.4 x 100 000 hab. en 2013) (CPA:-2,3), observándose tendencias decrecientes en 17 de 25 regiones políticas. Se encontraron diferencias: decremento más acelerado en mujeres (CPA-2,5) versus hombres (-2,0) y a mayor edad (CPA para 75-79 años:-2,57 versus CPA para 40-44:-1,39); destacan tres regiones con elevada mortalidad: Andes centrales, zona norte y costa central; existen tendencias crecientes en Huancavelica, Ayacucho y Pasco. En la Costa la mortalidad decrece desde 1998; en la Sierra y Selva decrece significativamente a partir del 2009. Conclusiones: La tendencia de la TME por cáncer gástrico fue decreciente para el período de 1995-2013 con disparidades por sexo, grupos etarios, regiones políticas y geográficas. Palabras clave: Tendencias; Tasa de mortalidad; Modelo de regresión segmentada; Análisis de regresión; Cáncer gástrico; Perú (fuente: DeCS BIREME).
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