Cost-Effectiveness of Breast Cancer Screening with Mammography and Ultrasound: A Study among Women in Phanat Nikhom District and Network Areas
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Abstract
BACKGROUND: Breast cancer rates in Thailand are increasing, with a concerning trend of diagnosis in younger women. Early detection increases the survival rate to 94.4%, with economic evaluation studies required to ensure the efficient allocation of budgets and screening tools across different regions.
OBJECTIVES: This cross-sectional analytical research was integrated with an economic evaluation to assess the cost-effectiveness of breast cancer screening using mammography combined with ultrasound (MMG+US).
METHODS: The study focused on 383 high-risk women aged 40–75 years in Phanat Nikhom District and the Chonburi provincial network. A Decision Tree Model was employed to compare opportunistic screening with systematic MMG+US screening. Outcomes were measured in Life-Years Gained (LYG) and the Incremental Cost-Effectiveness Ratio (ICER).
RESULTS: The sample was mostly (70%) aged between 50 and 69. Screening identified BIRADS 4–5 abnormalities in 8.3% of the participants. The proportion of Stage 0 and 1 breast cancer detected in the screened group was significantly higher than in the non-screened group. Consequently, the average life expectancy for the screened group increased from 19.87 to 23.01 years, representing Life Years Gained (LYG) of 3.14 years. The screening cost was 2,400 THB per person, with an Incremental Cost-Effectiveness Ratio (ICER) of 764 THB per LYG, indicating that, based on Thailand’s current threshold, the program was cost-effective.
CONCLUSIONS: Among high-risk women who underwent MMG+US screening, earlier stage detection (Stage 0–I) was more frequent than expected under opportunistic screening. Economic modeling based on observed stage distribution indicated that MMG+US screening was highly cost-effective within the Thai context. These findings support the targeted use of combined screening in high-risk women, particularly those aged 50 years and older.
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