Cost-utility evaluation of mammography screening program in Taiwan based on real-world data accounting for false positives.

Purpose: We estimated stage-specific loss of quality-adjusted life expectancy (loss-of-QALE) and weighted by stage distributions considering false-positive (FP) costs for cost-utility evaluation of mammography screening in Taiwan.

Methods: FP costs included related reimbursements by the National Health Insurance for inpatients' and outpatients' services within one year after positive screening without BC diagnosis. Using the EuroQol five dimensions questionnaire (EQ-5D-3L), we collected the utilities from 1,181 women who visited a medical center with 2,247 repeated measurements in 2011-2021. We used a rolling-over algorithm to extrapolate survival to lifetime to estimate QALEs by multiplying survival probability with utilities and the loss of QALEs by comparing with age- and calendar year-matched referents. We calculated the incremental cost-effectiveness ratio (ICER) yearly by comparing the stage proportion weighted sums of loss-of-QALE between women detected by screening versus non-screening within six-month observed intervals in 2004-2013.

Results: QALEs of stages I, II, III, and IV were 29.4, 25.0, 18.2, and 4.5 years, respectively, while loss-of-QALEs were 0.3, 4.2, 10.6, and 22.9 quality-adjusted life year (QALYs), respectively. A total of 355,489 (11.1 %) FP were found with an average cost of US$ 2,126 per screen-detected BC. After the nationwide promotion of mammography in 2010-2013, ICER was US$ 855 per QALY.

Conclusion: The mammography screening, which exceeded 530,000 women with a 22 % coverage rate, showed promising cost-utility; the ICER was about one-third of the willingness-to-pay (WTP) of one gross domestic product per QALY. Future studies are warranted to explore the saving of productivity loss from a societal perspective.