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Table 3 Interventions compared, study objectives, and main study conclusions of reviewed articles

From: Economic analyses of breast cancer control in low- and middle-income countries: a systematic review

Authors Interventions compared Study objective Conclusions by authors
Groot and colleagues, 2006 [28] Combinations of individual stage I to IV treatment and an extensive mammography screening control program To assess the cost-effectiveness of breast cancer control that covers various interventions in different settings Stage I treatment and an extensive screening control program are the most cost-effective interventions
Okonkwo and colleagues, 2008 [30] Mammography screening, CBE screening among different age groups and in different frequencies To assess which screening program should be implemented in India CBE screening in India compares favorably with mammography screening in developed countries
Munshi, 2009 [41] Several treatment interventions To present pragmatic cost-saving breast cancer interventions Intelligent use of knowledge about the disease can help us to exploit new techniques for maximum therapeutic gain with minimal investment
Sarvazyan and colleagues, 2008 [32] CBE, mammography, ultrasound, magnetic resonance imaging, biopsy, elasticity imaging, tactile imaging To review the diagnostic accuracy, procedure cost, and cost-effectiveness of currently available techniques for breast screening and diagnosis. Tactile imaging has the potential to provide cost-effective breast cancer screening and diagnosis
Fonseca and colleagues, 2009 [38] Anastrozole vs. tamoxifen in the adjuvant setting of early breast cancer To determine cost-effectiveness of anastrozole, compared with tamoxifen, in the adjuvant treatment of early stage breast cancer in Brazil Anastrozole is more cost-effective than tamoxifen in the adjuvant setting of early breast cancer
Ginsberg and colleagues, 2012 [27] Stage 1 to 4 treatment individual, treatment of all stages, biennial mammography screening 50 to 70 vs. null scenario To determine the cost-effectiveness of 81 interventions to combat breast, cervical and colorectal cancer at different geographic coverage levels, to guide resource allocation decisions in LMICs For breast cancer, although expensive, mammography screening in combination with treatment of all stages is cost-effective in both regions (I$2,248 to 4,596/DALY). Treating early-stage breast cancer is more cost-effective than treating late-stage disease
Salomon and colleagues, 2012 [31] Stage 1 to 4 treatment individual, treatment of all stages, screening (annual CBE >25 years + mammography annual >50 years + mammography biennial >40 to 49 years) vs. null scenario Analyze the cost-effectiveness of 101 intervention strategies directed at nine major clusters of NCDs in Mexico (including breast cancer), to inform decision-makers Treatment of all stages is cost-effective and treatment of early stages is more cost-effective than late stage treatment. Nationwide screening has an incremental CEA of I$22,000/DALY and is potentially cost-effective
Pakseresht and colleagues, 2011 [48] NA To estimate the expenditure audit of women with breast cancer in a tertiary hospital in Delhi Expenditure on treatment for breast cancer depends on many factors, including the size and stage of the cancer, the woman's age, use of private hospitals and insurance
Szynglarewicz and Matkowski, 2011 [33] Polish screening program costs vs. other countries To show preliminary results of the Polish screening program Population-based mammographic screening conforming the European quality standards is cost-effective even for middle-income countries
Yazihan and Yilmaz, 2006 [34] Mammography screening in age group 50 to 69 vs. treatment only To determine the efficiency of resource usage in mammography screenings and the impact on breast cancer stages in Turkey Mammography screening is economically attractive for Turkey
Bastani and Kiadaliri, 2012 [49] Docetaxel, doxorubicin and cyclophosphamide (TAC) vs. 5-fluorouracil, doxorubicin, cyclophosphamide (FAC) in node-positive breast cancer patients To evaluate the cost-utility of TAC and FAC in node-positive breast cancer patients FAC was a dominant option versus TAC in the short term. In this study, TAC resulted in higher costs and lower QALYs over the study period
Liubao and colleagues, 2009 [39] AC (doxorubicin/cyclophosphamide) vs. TC (docetaxel/cyclophosphamide) To estimate the cost-effectiveness of AC (doxorubicin/cyclophosphamide) vs. TC (docetaxel/cyclophosphamide) TC appears to be more effective and more costly than AC. TC may be viewed as cost-effective using the general WHO threshold
Astim, 2011 [36] Annual and biennial mammography screening in various age groups (40+, 45+, 50+, 55+, 60+ years) vs. no screening To evaluate the cost-effectiveness, optimal minimum age and screening interval for a screening program in Turkey Results of the simulation suggests that women over 40 in Turkey should be screened by mammography biennially
Zelle and colleagues, 2012 [35] Treatment interventions, biennial mammography and CBE screening interventions, awareness raising interventions, palliative care interventions vs. null scenario To analyze the cost, effects and cost-effectiveness of breast cancer control interventions in Ghana, and identify the optimal mix of interventions to maximize population health Both screening by clinical breast examination and mass media awareness raising seem economically attractive interventions ($1,299 and $1,364/DALY). Mammography screening is not cost-effective
Bai and colleagues, 2012 [42] Radiotherapy vs. no radiotherapy after surgery To assess the cost-effectiveness of additional radiotherapy for women with early breast cancer after breast-conserving surgery In health resource-limited settings, the addition of radiotherapy is a very cost-effective strategy (−$420/ QALY) in comparison with no-radio therapy in women with early breast cancer
Arredondo and colleagues, 1995 [43] Case management costs for infrastructure, human resources, laboratory, hospital stay, drugs, mastectomy, disposable material, curing material To develop a system for monitoring costs of case management for each disease (breast cancer, cardiac calve disease and enteritis and bronchopneumonia) Economic analyses hold important information for decision-making
Boutayeb and colleagues, 2010 [37] Three chemotherapy regimes, AC, AC + taxanes, AC + taxanes + trastuzumab To evaluate the total cost of chemotherapy in early stage breast cancer Moroccan health authorities need to devote between US$13.3 to 28.6 million to treat women by chemotherapy every year
Denewer and colleagues, 2010 [26] CBE-based screening with selective mammography vs. no screening To evaluate the disease pattern of screen-detected cancers and determine the effectiveness of CBE-based screening CBE-based screening with selective mammography is feasible, effective and improves the results of breast cancer management in Egypt
Guggisberg and colleagues, 2011 [46] On-site FNA clinic vs. shipping of specimens To assess the feasibility of an on-site cytopathology clinic in a rural hospital in Cameroon Cytopathology (FNA) is a reliable alternative for tissue diagnosis in low-resource settings
Kobayashi, 1988 [44] Costs and performance of breast echography in different institutions To analyze the economics and cost performance of breast echography in various institutions The best cost performance, internationally, can be achieved by mechanical and real-time electronic linear scanners
Love and colleagues, 2002 [40] Adjuvant oophorectomy and tamoxifen vs. oophorectomy and tamoxifen for recurrence after observation. To evaluate costs, disease-free and overall survival after surgical oophorectomy and tamoxifen in premenopausal Vietnamese women with operable breast cancer Vietnamese and Chinese women with hormone receptor-positive operable breast cancer benefit from adjuvant treatment with surgical oophorectomy and tamoxifen
Mousavi and colleagues, 2008 [29] Mammography screening in age groups 35 to 69 and 50 to 69 and no screening To decide whether mammography screening should be established in Iran or whether other options are needed Benefits of other policies than mammography screening need to be explored
Nasrinossadat and colleagues, 2011 [47] Methylene blue dye injections vs. wire localization To report experience in marking nonpalpable breast masses by injection of methylene dye Marking with methylene blue dye is a simple, effective and low-cost method for localization of nonpalpable breast masses
Thomas and colleagues, 1999 [45] FNA cytology vs. surgical tissue biopsy To assess the results and limitations of a Nigerian FNA clinic FNA cytology can help improve the management and cost of care of patients with palpable masses
  1. CEA, cost-effectiveness analysis; CBE, clinical breast examination; DALY, disability-adjusted life year; FNA, fine needle aspiration; LMIC, low- and middle-income country; NCD, noncommunicable disease; QALY, quality-adjusted life year; WHO, World Health Organization.