The National Cancer Screening Program for Breast Cancer in the Republic of Korea: Is it Cost-Effective?

Abstract

This goal of this research was to evaluate the cost-effectiveness of the National Cancer Screening Program (NCSP) for breast cancer in the Republic of Korea from a government expenditure perspective. In 2002-2003 (baseline), a total of 8,724,860 women aged 40 years or over were invited to attend breast cancer screening by the NCSP. Those who attended were identified using the NCSP database, and women were divided into two groups, women who attended screening at baseline (screened group) and those who did not (non-screened group). Breast cancer diagnosis in both groups at baseline, and during 5-year follow-up was identified using the Korean Central Cancer Registry. The effectiveness of the NCSP for breast cancer was estimated by comparing 5-year survival and life years saved (LYS) between the screened and the unscreened groups, measured using mortality data from the Korean National Health Insurance Corporation and the National Health Statistical Office. Direct screening costs, indirect screening costs, and productivity costs were considered in different combinations in the model. When all three of these costs were considered together, the incremental cost to save one life year of a breast cancer patient was 42,305,000 Korean Won (KW) (1 USD=1,088 KW) for the screened group compared to the non-screened group. In sensitivity analyses, reducing the false-positive rate of the screening program by half was the most cost-effective (incremental cost-effectiveness ratio, ICER=30,110,852 KW/LYS) strategy. When the upper age limit for screening was set at 70 years, it became more cost-effective (ICER=39,641,823 KW/LYS) than when no upper age limit was set. The NCSP for breast cancer in Korea seems to be accepted as cost-effective as ICER estimates were around the Gross Domestic Product. However, cost-effectiveness could be further improved by increasing the sensitivity of breast cancer screening and by setting appropriate age limits.

Is Mammography for Breast Cancer Screening Cost-Effective in Both Western and Asian Countries?: Results of a Systematic Review

“…As illustrated in Table 4, when the countries are Woo et al, 2007;3 : Carles et al, 2011;4 : Garuz et al, 1997;5 : Van der Maas et al, 1989;6 divided into two groups, one including India (Okonkwo et al, 2008), Japan (Okubo et al, 1991), China (Woo et al, 2007;Wong et al, 2010), and Korea (Kang et al, 2013), and the other including the UK (Knox, 1988), (Leivo et al, 1999), The Netherlands (Leivo et al, et al, 2009), and the US (Lindfors and Rosenquist, 1995;Rosenquist and Lindfors, 1998;Stout et al, 2006;Wong et al, 2010;Schousboe et al, 2011) on the basis of the cut-off point of 45.04 for the incidence rates, there was Asian and Western countries. This illustrates that there is difference in the cost-effectiveness of breast cancer mammography screening between Asian countries such as India, Japan, China, and Korea with low incidence rates, and Western countries such as the UK, Spain, Finland, with relatively higher incidence rates.…”

“…Among 16 studies, 11 studies (de Koning et al, 1991;and Lindfors, 1998;Stout et al, 2006;Woo et al, 2007;Okonkwo et al, 2008;de Gelder et al, 2009;Wong et al, 2010;Carles et al, 2011;Schousboe et al, 2011) of scenarios. The other 5 studies (Knox, 1988;Okubo et al, 1991;Leivo et al, 1999;Norum, 1999;Kang et al, the cost-effectiveness of a single screening strategy, with the mammography screening strategy that was being implemented in the corresponding country at that time. In Schousboe et al's (2011) study, the cost per LYS was reduced even further as age increased under the same intervals.…”

Comparison of Automated Breast Volume Scanning and Hand-Held Ultrasound in the Detection of Breast Cancer: an Analysis of 5,566 Patient Evaluations

“…In Korea, mammography is implemented for breast cancer screening with controversy in cost-effectiveness (Kang et al, 2013;Yoo et al, 2013). Mammography has well recognized limitations, such as reduced sensitivity of both screening and diagnostic mammography in dense breast tissue by as much as 50% compared with fatty breast tissue (Kolb et al, 2002;Berg et al, 2004;Boyd et al, 2007).…”

Cancer Control Programs in East Asia: Evidence From the International Literature

“…Whether screening will be beneficial and cost-effective is often unclear but the country with the most highly developed and attended screening program in East Asia, Korea, has generated compelling evidence that cost for life year saved is below the per capita gross domestic product for most major cancers[80-82]. …”

“…However, this was not confirmed in Thailand[111]. Cost-effectiveness needs to be improved by increasing the sensitivity of breast cancer screening and by setting appropriate age limits[82]. …”