Cost-Effectiveness of National Breast Cancer Screening Programs in Developing Countries, with Reference to the Recent Egyptian Initiative

Abstract

Breast cancer was the second most common cancer in the world and the most common cancer in women both in developed and less developed world. It ranked the fifth cause of death from all cancers and caused the greatest number of cancer related deaths among women in 2018. A variety of factors have been shown to impact an individual’s risk of developing breast cancer and its ultimate prognosis. Screening for breast cancer will help to reduce mortality, to confer lifetime protection, and to protect those with high risk factors. Cost-effectiveness analysis refers to the economic evaluation in which the costs and consequences of alternative interventions are expressed in cost per unit of health outcome. Studies on cost-effectiveness of screening programs in developing countries used different methods and calculated different outcome measures. They studied different tools used for screening. Some studied the cost-effectiveness of clinical breast examination and others studied that of mammography. The outcome measures varied, some studies calculated the cost-effectiveness ratio, while others calculated the incremental cost-effectiveness ratio, the disability adjusted life years and the quality adjusted life years. It is concluded that although population-based mammography has been widely adopted in high-income countries, it is less cost–effective in low- and middle-income countries which face some challenges such as the problem of investment in screenings. In developing countries, further research to study the cost-effectiveness of breast cancer screening, covering a comprehensive set of interventions and resulting in clear policy recommendations, is required.