Breast Cancer Screening in Georgia: Choosing the Most Optimal and Cost-Effective Strategy

Objectives: To define the optimal and cost-effective breast cancer screening strategy for Georgia.Methods: We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses.Results: Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (euro16 218/QALY), well above the willingness-to-pay threshold of euro12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of euro12 507.Conclusions: Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.

Automated summary

This study used the MISCAN-Breast model to evaluate 736 breast cancer mammography screening strategies. The results showed that strategies combining mammography and clinical breast examination (CBE) had higher costs and minimal differences in outcomes compared to mammography-only strategies. The current strategy in Georgia, biennial mammography screening from 40 to 70 years with CBE, is close to the optimal strategy but requires high additional costs. The optimal strategy for Georgia would be triennial mammography-only screening from 45 to 66 years.