PMID- 34281995
OWN - NLM
STAT- MEDLINE
DCOM- 20210730
LR  - 20231107
IS  - 2632-1009 (Electronic)
IS  - 2632-1009 (Linking)
VI  - 28
IP  - 1
DP  - 2021 Jul
TI  - Telemammography for breast cancer screening: a cost-effective approach in 
      Argentina.
LID - 10.1136/bmjhci-2021-100351 [doi]
LID - e100351
AB  - OBJECTIVES: Argentina is a low and middle-income country (LMIC) with a highly 
      fragmented healthcare system that conflicts with access to healthcare stated by 
      the country's Universal Health Coverage plan. A tele-mammography network could 
      improve access to breast cancer screening decreasing its mortality. This research 
      aims to conduct an economic evaluation of the implementation of a 
      tele-mammography program to improve access to healthcare. METHODS: A cost-utility 
      analysis was performed to explore the incremental benefit of annual 
      tele-mammography screening for at-risk Argentinian women over 40 years old. A 
      Markov model was developed to simulate annual mammography or tele-mammography 
      screening in two hypothetical population-based cohorts of asymptomatic women. 
      Parameter uncertainty was evaluated through deterministic and probabilistic 
      sensitivity analysis. Model structure uncertainty was also explored to test the 
      robustness of the results. RESULTS: It was estimated that 31 out of 100 new cases 
      of breast cancer would be detected by mammography and 39/100 by tele-mammography. 
      The model returned an incremental cost-effectiveness ratio (ICER) of  pound26 
      051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended 
      threshold of  pound26 288/QALY for Argentina. Deterministic sensitivity analysis 
      showed the ICER is most sensitive to the uptake and sensitivity of the screening 
      tests. Probabilistic sensitivity analysis showed tele-mammography is 
      cost-effective in 59% of simulations. DISCUSSION: Tele-mammography should be 
      considered for adoption as it could improve access to expertise in underserved 
      areas where adherence to screening protocols is poor. Disaggregated data by 
      province is needed for a better- informed policy decision. Telemedicine could 
      also be beneficial in ensuring the continuity of care when health systems are 
      under stress like in the current COVID-19 pandemic. CONCLUSION: There is a 59% 
      chance that tele-mammography is cost-effective compared to mammography for 
      at-risk Argentinian women over 40- years old, and should be adopted to improve 
      access to healthcare in underserved areas of the country.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Malek Pascha, Victoria Alba
AU  - Malek Pascha VA
AUID- ORCID: 0000-0001-6322-5168
AD  - Health Services Research and Policy, Faculty of Public Health and Policy, London 
      School of Hygiene & Tropical Medicine, London, UK 
      victoria.malek-pascha1@alumni.lshtm.ac.uk.
AD  - School of Public Health, Faculty of Medicine, University of Buenos Aires, Buenos 
      Aires, Argentina.
FAU - Sun, Li
AU  - Sun L
AD  - Health Services Research and Policy, Faculty of Public Health and Policy, London 
      School of Hygiene & Tropical Medicine, London, UK.
FAU - Gilardino, Ramiro
AU  - Gilardino R
AD  - Health Services Research and Policy, Faculty of Public Health and Policy, London 
      School of Hygiene & Tropical Medicine, London, UK.
AD  - School of Public Health, Faculty of Medicine, University of Buenos Aires, Buenos 
      Aires, Argentina.
FAU - Legood, Rosa
AU  - Legood R
AD  - Health Services Research and Policy, Faculty of Public Health and Policy, London 
      School of Hygiene & Tropical Medicine, London, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - BMJ Health Care Inform
JT  - BMJ health & care informatics
JID - 101745500
SB  - IM
MH  - Adult
MH  - Argentina
MH  - *Breast Neoplasms/diagnosis/economics
MH  - COVID-19
MH  - Cost-Benefit Analysis/*economics
MH  - Early Detection of Cancer/*economics
MH  - Female
MH  - Health Services Accessibility
MH  - Humans
MH  - Mammography/*economics
MH  - *Medical Informatics
MH  - Middle Aged
MH  - Quality-Adjusted Life Years
MH  - *Telemedicine
MH  - Vulnerable Populations
PMC - PMC8290945
OTO - NOTNLM
OT  - BMJ health informatics
OT  - COVID-19
OT  - health equity
OT  - information systems
OT  - public health
COIS- Competing interests: None declared.
EDAT- 2021/07/21 06:00
MHDA- 2021/07/31 06:00
PMCR- 2021/07/19
CRDT- 2021/07/20 06:11
PHST- 2021/03/01 00:00 [received]
PHST- 2021/06/22 00:00 [accepted]
PHST- 2021/07/20 06:11 [entrez]
PHST- 2021/07/21 06:00 [pubmed]
PHST- 2021/07/31 06:00 [medline]
PHST- 2021/07/19 00:00 [pmc-release]
AID - bmjhci-2021-100351 [pii]
AID - 10.1136/bmjhci-2021-100351 [doi]
PST - ppublish
SO  - BMJ Health Care Inform. 2021 Jul;28(1):e100351. doi: 10.1136/bmjhci-2021-100351.