Economic analyses of breast cancer control in low- and middle-income countries: a systematic review
Zelle and Baltussen Systematic Reviews
0 Department of Primary and Community Care, Radboud University Nijmegen Medical Centre , P.O. Box 9101Internal Postal Code 117, 6500HB Nijmegen , the Netherlands
1 Thomas and colleagues , 1999 [45]
2 Zelle and colleagues , 2012 [35]
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Economic analyses of breast cancer
low- and middle-income countries: a
review
control in
systematic
Zelle and
Open Access
Economic analyses of breast cancer control in
low- and middle-income countries: a systematic
review
Sten G Zelle* and Rob M Baltussen
Results: The majority of these studies were of poor quality, particularly in examining costs. Studies demonstrated
the economic attractiveness of breast cancer screening strategies, and of novel treatment and diagnostic
interventions.
Background
Noncommunicable diseases (NCDs) have become
increasingly important in low- and middle-income countries
(LMICs). Once considered a problem only in high-income
countries (HICs), more and more patients who suffer from
cancers and other NCDs are now observed in LMICs [1].
This is mainly due to the ageing populations and changing
lifestyles in LMICs [2]. The global importance of NCDs has
recently been acknowledged through the UN Summit on
NCDs, held by the UN General Assembly in September
2011. As highlighted in the summit, the most prominent
cause of cancer death among women in LMICs is
breast cancer, accounting for 269,000 deaths (12.7% of
all cancer deaths) in 2008 [3,4].
In HICs, many efforts have been undertaken to control
breast cancer, leading to various improvements in breast
cancer outcomes [5,6]. Strategies for breast cancer
control are geared towards early detection and early
treatment, and although its benefits are still open to
discussion [7-9], mammography screening has been widely
implemented [10-12]. In these countries, the selection of
breast cancer control strategies has often been guided by
economic analyses, demonstrating the value of alternative
interventions [13-16].
In contrast to the established breast cancer control
strategies in HICs, breast cancer is often neglected in
LMICs and control strategies lack evidence-based
information [17-20]. Policy-makers in LMICs cannot adopt
similar breast cancer control strategies as implemented in
HICs because most LMICs rely on much smaller budgets,
and both the costs and effectiveness of control strategies
are highly dependent on the population characteristics
and the functioning of the health system [11,20,21].
Against this background, the present review provides
an inventory of economic analyses of breast cancer
control in LMICs. The paper’s objectives are to present
the available economic evidence from LMICs and to
assess the methodological quality of the analyses. This
research could improve the evidence base on cost-effective
breast cancer interventions and could strengthen breast
cancer control policy in LMICs.
Methods
Search strategy and selection criteria
In this review, we analyzed publications from the
MEDLINE index using PubMed, the Web of Science,
Scopus, and Google Scholar. We searched the literature
using the keyword ‘breast cancer’, combined with the
keywords: ‘developing countries’, ‘Asia’, ‘USSR’,
‘MiddleEast’, ‘Eastern Europe’, ‘West-Indies’, ‘China’, ‘Russia’, ‘India’,
‘Africa,’ or ‘limited resource,’ or combined with: ‘cost-benefit,’
‘cost-effectiveness,’ ‘costing,’ or ‘cost analysis’. Additionally,
we searched these indexes using ‘breast neoplasms’,
‘developing countries,’ and ‘economics’ in MeSH terms.
Our search took place in January 2013, and was limited to
publications in English. Studies were included only if they
concerned breast cancer and originated from LMICs as
listed by The World Bank [22].
The selection process is shown in Figure 1. In step 1,
articles found by our search in the various indexes
were merged in a database, which was then corrected
for duplications (in Google Scholar, because of the
large number of articles founds, we screened titles
until the point that we did not find any further relevant
title among the last 500 screened titles; in total, we
screened 800 titles in this database). In step 2 we
screened the titles of these articles, in step 3 the
abstracts and in step 4 the remaining articles were read
completely. We excluded publications for which no
full-text article versions were available, or those not
published in English. Furthermore, we excluded articles
that only mentioned costs or cost-effectiveness without
presenting original data.
Study characteristics
We documented the following characteristics from the
reviewed articles: country or region, base year of cost data,
study population, and breast cancer stage(s) considered.
The stage was categorized as stage I to IV according to the
American Joint Committee on Cancer [23].
We documented the following methodological
characteristics: type of economic evaluation –cost analysis
or cost of illness analysis, separately reported costs and
effects, cost-effectiveness analysis, (...truncated)