COST-EFFECTIVENESS OF INTEGRATING BREAST CANCER SCREENING INTO AN EXISTING CERVICAL CANCER SCREENING PROGRAM IN CAMEROON
Author(s)
HuiHsuan Chan, MS1, Monisha Sharma, PhD2, Florence Manjuh, BS3, Lily Gutnik, MD4;
1University of Washington, Student, SEATTLE, WA, USA, 2University of Washington, Seattle, WA, USA, 3Cameroon Baptist Convention Health Service, BAMENDA, Cameroon, 4University of Alabama at Birmingham, Birmingham, AL, USA
1University of Washington, Student, SEATTLE, WA, USA, 2University of Washington, Seattle, WA, USA, 3Cameroon Baptist Convention Health Service, BAMENDA, Cameroon, 4University of Alabama at Birmingham, Birmingham, AL, USA
OBJECTIVES: Breast cancer is the leading cause of female cancer mortality in Cameroon, driven by limited screening. Clinical Breast Exam (CBE) is a recognized early-detection method. We aimed to estimate the cost effectiveness and mortality benefit of integrating CBE into Cameroon’s largest existing cervical cancer screening program within a nonprofit health system.
METHODS: We developed hybrid cohort and decision tree models to simulate the breast health trajectory of screen-eligible Cameroonian women aged 30-69 years from health system’s perspective. A decision tree simulated annual screen-detected and symptomatically detected cases. Women were then assigned to parallel Markov models : screen-detected and treated, symptomatically detected and treated, or detected but untreated breast cancer. Models included stage I-IV disease and death. Screening benefits reflected stage downstaging for treated screen-detected cases. Treated women remained in their diagnosed stage, while untreated women progressed according to natural history of breast cancer. We simulated two strategies: cervical cancer screening alone and integrated cervical cancer plus CBE screening . Women diagnosed with breast cancer were followed over their remaining lifetime, beginning at the midpoint age of their respective age band. Cost inputs were obtained from a clinic-based micro-costing in Cameroon and included CBE training costs and nursing time. Epidemiological parameters, disability weights, and downstaging effects were sourced from published literature.
RESULTS: The incremental cost of integration was US$563,380. Total disability-adjusted life years (DALYs) were 10,430,105 under cervical-only screening and 5,085,181 under integrated screening, leading to 5,344,924 (51%)DALYs averted. Estimated breast cancer deaths were 1,588,314 and 795,750 respectively, resulting in 792,564 (50%) deaths averted. The ICER was US$0.11 per DALY averted and US$0.71 per breast cancer death averted.
CONCLUSIONS: Integrating CBE into the Cameroon’s cervical cancer screening program reduces breast cancer mortality and disease burden and is highly cost-effective; supporting integrated women’s cancer screening in resource-limited settings.
METHODS: We developed hybrid cohort and decision tree models to simulate the breast health trajectory of screen-eligible Cameroonian women aged 30-69 years from health system’s perspective. A decision tree simulated annual screen-detected and symptomatically detected cases. Women were then assigned to parallel Markov models : screen-detected and treated, symptomatically detected and treated, or detected but untreated breast cancer. Models included stage I-IV disease and death. Screening benefits reflected stage downstaging for treated screen-detected cases. Treated women remained in their diagnosed stage, while untreated women progressed according to natural history of breast cancer. We simulated two strategies: cervical cancer screening alone and integrated cervical cancer plus CBE screening . Women diagnosed with breast cancer were followed over their remaining lifetime, beginning at the midpoint age of their respective age band. Cost inputs were obtained from a clinic-based micro-costing in Cameroon and included CBE training costs and nursing time. Epidemiological parameters, disability weights, and downstaging effects were sourced from published literature.
RESULTS: The incremental cost of integration was US$563,380. Total disability-adjusted life years (DALYs) were 10,430,105 under cervical-only screening and 5,085,181 under integrated screening, leading to 5,344,924 (51%)DALYs averted. Estimated breast cancer deaths were 1,588,314 and 795,750 respectively, resulting in 792,564 (50%) deaths averted. The ICER was US$0.11 per DALY averted and US$0.71 per breast cancer death averted.
CONCLUSIONS: Integrating CBE into the Cameroon’s cervical cancer screening program reduces breast cancer mortality and disease burden and is highly cost-effective; supporting integrated women’s cancer screening in resource-limited settings.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE362
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology