Cost-utility evaluation of mammography screening program in Taiwan based on real-world data accounting for false...

We estimated stage-specific loss of quality-adjusted life expectancy (loss-of-QALE) and weighted by stage distributions considering false-positive (FP) costs for cost-utility evaluation of mammography screening in Taiwan.

FP costs included related reimbursements by the National Health Insurance for inpatients' and outpatients' services within one year after positive screening without BC diagnosis. Using the EuroQol five dimensions questionnaire (EQ-5D-3L), we collected the utilities from 1,181 women who visited a medical center with 2,247 repeated measurements in 2011-2021. We used a rolling-over algorithm to extrapolate survival to lifetime to estimate QALEs by multiplying survival probability with utilities and the loss of QALEs by comparing with age- and calendar year-matched referents. We calculated the incremental cost-effectiveness ratio (ICER) yearly by comparing the stage proportion weighted sums of loss-of-QALE between women detected by screening versus non-screening within six-month observed intervals in 2004-2013.

QALEs of stages I, II, III, and IV were 29.4, 25.0, 18.2, and 4.5 years, respectively, while loss-of-QALEs were 0.3, 4.2, 10.6, and 22.9 quality-adjusted life year (QALYs), respectively. A total of 355,489 (11.1 %) FP were found with an average cost of US$ 2,126 per screen-detected BC. After the nationwide promotion of mammography in 2010-2013, ICER was US$ 855 per QALY.

The mammography screening, which exceeded 530,000 women with a 22 % coverage rate, showed promising cost-utility; the ICER was about one-third of the willingness-to-pay (WTP) of one gross domestic product per QALY. Future studies are warranted to explore the saving of productivity loss from a societal perspective.