Cost-Effectiveness Analysis of Mammography-Based Breast Cancer Screening in Indonesia

OBJECTIVES: The Indonesian government has not implemented mammography as national screening program. Therefore, we evaluated the cost-effectiveness of mammography-based breast cancer screening strategy in Indonesia from a societal perspective.

METHODS: The Simulation Model on radiation Risk and breast cancer Screening was used to examine various breast cancer screening scenarios, including different screening age (40-65 vs 35-65 years), frequency (every 2, 3, 4, or 5 years), and participation rate (50%, 70%, and 100%). The model's input parameters were independently derived from published population statistics and systematic literature.

RESULTS: Our findings indicate that, across all scenarios, mammography screening was cost-effective compared with no screening under the following conditions: (1) screening women aged 40 to 65 every 4 years at 50% participation rate, (2) screening women aged 40 to 65 every 4 years at 70% participation rate, (3) screening women aged 40 to 65 every 3 years at 70% participation rate, and (4) screening women aged 40 to 65 every 2 years at 100% participation rate. The incremental cost-effectiveness ratios these scenarios compared with the next best alternative were $4758 per life year gained (US dollars/LYG), $5263/LYG, $5436/LYG, and $7569/LYG, respectively, all of which were less than 3 times Indonesia's gross domestic product per capita.

CONCLUSIONS: We recommend implementing mammography screening as a national program in Indonesia. The cost-effectiveness of screening strategies depends on factors such as participation rates, screening age, frequency, and the government's willingness-to-pay threshold. We recognize Indonesia's competing health priorities and limited resources. Acknowledging these priorities will help policymakers in making informed decisions about resource allocation.