Cost-Effectiveness of Clinical Breast Examination As Screening Modality for Breast Cancer in Vietnam: A Markov Modelling
Author(s)
Ngan T. Tran, PhD1, Van Minh Hoang, MD, PhD2, Michael Donnelly, PhD1, ciaran o'neill, PhD1.
1Queen's University Belfast, Belfast, United Kingdom, 2Hanoi University of Public Health, Hanoi, Viet Nam.
1Queen's University Belfast, Belfast, United Kingdom, 2Hanoi University of Public Health, Hanoi, Viet Nam.
OBJECTIVES: Mammography is the primary screening tool for breast cancer (BC) in high-income countries, but it is not feasible for many low- and middle-income countries (LMICs), including Vietnam. With 65% of new BC cases diagnosed at late stages and no national screening programme in place, this study assessed the cost-effectiveness of a clinical breast examination (CBE) screening programme-an affordable alternative-compared to no screening.
METHODS: A multi-state Markov model with ten health states was developed to simulate BC progression over a lifetime for a cohort of 100,000 healthy Vietnamese women starting at age 35. The states included well, stage I-IV, survivor, recurrence (local/distant), and death (from BC or other causes). Of which, 4 tunnel states are stage I-III (move to survivor or death after 1 cycle) and local recurrence (move to either survivor or distance recurrence or death after 1 cycle). The model used a 1-year cycle length and applied a 1.5% annual discount rate for costs and outcomes; both were primary data collected from patients. Transition probabilities were the same for both scenarios ‘no screening’ and ‘CBE’, except for transitions from the well state to stage I-IV, reflecting CBE’s down-staging effect. Outcomes were measured in quality-adjusted life years (QALYs). The base-case analysis reported the incremental cost-effectiveness ratio (ICER) per QALY gained from the patient perspective.
RESULTS: Compared to no screening, the CBE screening programme yielded an ICER of 5.98 million VND (~$232) per QALY gained, which is well below Vietnam’s GDP per capita (63.2 million VND, ~$2,449). Monte Carlo simulation in PSA confirmed the robustness of the finding, with all 1000 iterations falling below the highly cost-effective threshold.
CONCLUSIONS: CBE-based BC screening in Vietnam is highly cost-effective and nearly dominant compared to no screening. Given its affordability and feasibility, CBE should be considered a best-choice intervention for Vietnam and similar LMICs.
METHODS: A multi-state Markov model with ten health states was developed to simulate BC progression over a lifetime for a cohort of 100,000 healthy Vietnamese women starting at age 35. The states included well, stage I-IV, survivor, recurrence (local/distant), and death (from BC or other causes). Of which, 4 tunnel states are stage I-III (move to survivor or death after 1 cycle) and local recurrence (move to either survivor or distance recurrence or death after 1 cycle). The model used a 1-year cycle length and applied a 1.5% annual discount rate for costs and outcomes; both were primary data collected from patients. Transition probabilities were the same for both scenarios ‘no screening’ and ‘CBE’, except for transitions from the well state to stage I-IV, reflecting CBE’s down-staging effect. Outcomes were measured in quality-adjusted life years (QALYs). The base-case analysis reported the incremental cost-effectiveness ratio (ICER) per QALY gained from the patient perspective.
RESULTS: Compared to no screening, the CBE screening programme yielded an ICER of 5.98 million VND (~$232) per QALY gained, which is well below Vietnam’s GDP per capita (63.2 million VND, ~$2,449). Monte Carlo simulation in PSA confirmed the robustness of the finding, with all 1000 iterations falling below the highly cost-effective threshold.
CONCLUSIONS: CBE-based BC screening in Vietnam is highly cost-effective and nearly dominant compared to no screening. Given its affordability and feasibility, CBE should be considered a best-choice intervention for Vietnam and similar LMICs.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD315
Topic Subcategory
Reproducibility & Replicability
Disease
SDC: Oncology