Cost-effectiveness analysis of mammography screening for early detection of breast cancer in Nigeria

by Ifeoma Jovita Nduka, Charles Ebuka Okafor, Obinna Ikechukwu Ekwunife

Mammography still remains the gold standard for breast cancer screening, considering its impact on breast cancer mortality. However, it has a relatively low utilization rate in Nigeria. Although the National Strategic Cancer Control Plan (NSCCP) has a goal of making screening services and early detection of cancer available for all Nigerians, there is currently no national breast cancer screening program implemented in Nigeria. The modelling study aimed to evaluate the cost-effectiveness of mammography screening from the healthcare provider’s perspective and to determine the appropriate screening interval for Nigerian women, aiming to enhance the efficiency and effectiveness of breast cancer detection programs. A state-transition Markov model was adapted to simulate annual and biennial mammography, breast cancer diagnosis, and treatment in a cohort of cancer-free Nigerian women aged 40 years and followed them for a lifetime. The study was conducted from the healthcare provider’s perspective. Disability-adjusted life year (DALY) averted, representing the health outcomes, was used to estimate the incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted at an annual rate of 5%. Annual mammography screening costs US$238.60, averted a DALY of 1.060, and was the most cost-effective intervention with an ICER of US$207.24 (95% CI US$213.31 – US$216.88)/DALY averted, which was below the willingness-to-pay threshold of $1074. Mammography screening strategies were estimated to be cost-effective from the healthcare payer’s perspective under the model assumptions. Annual screening showed the most favorable cost-effectiveness profile among the strategies evaluated, but this finding is model-dependent and should be interpreted as comparative economic evidence rather than a definitive screening recommendation. These results can inform future research, policy discussions, and consideration of sustainable financing for breast cancer screening in Nigeria.

Developing consensus definitions and methods for non-visually impairing eye conditions for population-based eye surveys in Nigeria: a Delphi study

Objective

To establish consensus definitions for non-visually impairing eye conditions (NVICs) and their methods of assessments to provide standards for use in population-based eye surveys.

Design

A literature review of NVICs in sub-Saharan Africa, a questionnaire of inquiry based on the literature review developed by an expert panel and a modified Delphi exercise with three iterative rounds with eye health experts.

Setting

Eye health academia and community eye health in Nigeria.

Participants

Nigerian ophthalmologists, including subspecialists experienced in population-based eye health surveys.

Main outcome measures

Definitions and statements where at least 70% of the respondents agreed or strongly agreed.

Results

Forty-two ophthalmologists practising in Nigeria with experience in conducting population-based eye health surveys were invited to take part in the Delphi exercise. There were three rounds with response rates of 39/42 (92.9%) in round 1, (94.9%) in round 2 and 100% in round 3. Consensus for NVICs to be included in population-based eye surveys, their definitions and methods for assessment was reached by the third round.

Conclusions

We propose case definitions for NVICs to be assessed in population-based eye surveys through a modified Delphi approach with an expert panel of ophthalmologists from across Nigeria. These case definitions will allow for standardisation of NVICs in population-based eye surveys to assess the prevalence and magnitude of the different types of NVICs for planning purposes. Further studies are needed to validate these case definitions and inform their evolution.