Authors' objectives: To facilitate the early detection and treatment of breast cancer, this study bases its analysis on the current breast cancer screening subsidy program and evaluates the cost-effectiveness of expanding the screening strategy by adjusting the age range and screening frequency. The aim was to assess the benefits of promoting expanded breast cancer screening and to provide a reference for future adjustments to breast cancer prevention and screening policies.

Authors' results and conclusions: According to the cost-effectiveness analysis, with a willingness to pay (WTP) threshold of 1 time the GDP per capita (approximately NTD 1,000,000/QALY gained), the expanded screening strategies proposed in this study were cost-effective compared to the current screening strategy (women aged 40-69 with a family history, and 45-69 without, both screened every two years). Among them, Strategy 4 (women aged 40-69, screened every two years) had the lowest ICER, approximately NTD 544,147 per QALY gained. The expanded screening strategy expected to be implemented in Taiwan (Strategy 5: women aged 40-74, screened every two years) had an ICER of approximately NTD 779,623 per QALY gained. If all strategies were compared in a probabilistic sensitivity analysis, the results showed that Strategy 6 was most likely to be cost-effective (screening annually for those aged 35-69 with a family history, and every two years for those aged 40-69 without a family history); if clinical evidence was considered and strategies under age 40 were excluded, Strategy 9 was most likely to be cost-effective (screening annually for those aged 40-69 with a family history, and every two years for those without a family history). However, the lack of sensitivity parameters for screening in the younger population might overestimate the benefits of routine screening in this group. Therefore, interpretation of the four strategic analyses regarding expanding screening to age 35 should be approached with caution. According to the financial impact analysis, expanding the screening scope to aged 40-74 and conducting screenings every two years would result in a financial impact of NTD 390 million in the first year and NTD 369 million in the fifth year for the National Health Promotion Administration.

Authors' recommendations: It is recommended that, given budget constraints, expanding screening eligibility to younger populations should be prioritized. Furthermore, considering clinical evidence, it is recommended to initially expand the scope to individuals aged 40 and above, with subsequent evaluation to be conducted once sufficient clinical evidence supports comprehensive screening for those under 40. According to the research results, the findings will be adopted and applied to expand the scope of key cancer screening covered by public funding in 2025, increasing the age range for government-subsidized breast cancer screening from 45-69 years old to 40-74 years old for women.

Authors' methods: The research method involved searching for and compiling relevant policies on breast cancer screening in neighboring Asian countries. Subsequently, an electronic database was used to search for published literature on the cost-effectiveness of breast cancer screening in Taiwan and internationally, to understand the model structures and obtain parameter acquisition methods and sources. Simultaneously, data on breast cancer screening collected in Taiwan in recent years was compiled and analyzed to obtain relevant local epidemiological parameters for the model. Following this, a cost-effectiveness model applicable to the Taiwanese context was established, and a cost-effectiveness analysis of breast cancer screening in Taiwan was performed based on screening strategies planned in alignment with the policy promotion direction of the National Health Promotion Administration of the Ministry of Health and Welfare. Finally, the financial impact of expanding the screening strategy was estimated, to serve as a reference for the government's budget allocation for expanding breast cancer screening policy.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.cde.org.tw/media/u2noykge/%E9%A0%90%E9%98%B2%E4%BF%9D%E5%81%A5%E4%B9%B3%E6%88%BFx%E5%85%89%E6%94%9D%E5%BD%B1%E8%A3%9C%E5%8A%A9%E5%B9%B4%E9%BD%A1%E5%8F%8A%E9%A0%BB%E7%8E%87%E8%AA%BF%E6%95%B4%E4%B9%8B%E6%88%90%E6%9C%AC%E6%95%88%E7%9B%8A%E8%A9%95%E4%BC%B0-%E6%91%98%E8%A6%81.pdf?mediaDL=true

English language abstract: There is no English language summary available

Publication Type: Not Assigned

Organisation Name: Center for Drug Evaluation

Contact Address: 3F.,No.465, Sec.6, Zhongxiao E. Rd., Taipei 11557, Taiwan. R.O.C.

Contact Name: Li Ying (Grace) Huang

Contact Email: lyhuang277@cde.org.tw