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

Abstract

ObjectivesArgentina 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.MethodsA 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.ResultsIt 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.DiscussionTele-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.ConclusionThere 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.

Breast cancer screening strategy: what can we learn?

“…[22]. Although some younger women may benefit from screening [30], a risk-based screening strategy may help to reduce the number of unnecessary diagnostic procedures performed on older, low-risk women.…”

Telehealth in breast cancer following the coronavirus disease 2019 pandemic

“…Since the pandemic, some centers in Argentina started using telemedicine with the intention to improve screening outcomes. Indeed, Malek Pascha et al [ 46 ] estimate that tele-mammography allows the detection of 39 out of 100 new BC cases whereas conventional mammography detects 31 of 100. Cost-effectiveness was also among the advantages, especially for underserved areas [ 46 ].…”

“…Indeed, Malek Pascha et al [ 46 ] estimate that tele-mammography allows the detection of 39 out of 100 new BC cases whereas conventional mammography detects 31 of 100. Cost-effectiveness was also among the advantages, especially for underserved areas [ 46 ]. Wearable sensors can also contribute to the early detection of BC at a distance.…”

“…Dietary interventions are among other digital health services that can potentially serve BC patients. In a trial protocol suspended because of the pandemic that was continued at a later time, Ueland and colleagues [45], enrolled patients with early BC into a group that receives numerous sessions of digital health intervention through video call in comparison to a group that receives a single session. Sessions included interactive nutritional and physical activity interventions.…”

The Global Status of Universal Health Coverage and Oncology Care

“…Community awareness of screening programs and increasing the understanding of the target population of the screening procedures and their benefits and hazards are a cornerstone for acceptance and utility of screening at the community level (5). Telemedicine and digital health could potentially expand the screening programs (6).…”