Mariana Brandão1,2,3, Assucena Guisseve4,5, Carla Carrilho1,4,5, Nuno Lunet1,2, Genoveva Bata6, João Firmino-Machado1,2, Matos Alberto5, Josefo Ferro7, Carlos Garcia7, Clésio Zaqueu8, Astrilde Jamisse9, Cesaltina Lorenzoni4,5,10, Martine Piccart-Gebhart3, Dina Leitão11,12,13, Jotamo Come14, Otília Soares6, Alberto Gudo-Morais6,15, Fernando Schmitt11,12, Satish Tulsidás1,2,6. 1. EPIUnit - Instituto de Saúde Pública, Porto, Portugal. 2. Departamentos de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal. 3. Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Pathology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique. 5. Department of Pathology, Maputo Central Hospital, Maputo, Mozambique. 6. Oncology, Maputo Central Hospital, Maputo, Mozambique. 7. Department of Pathology, Beira Central Hospital, Beira, Mozambique. 8. Department of Pathology, Nampula Central Hospital, Nampula, Mozambique. 9. Radiology, Maputo Central Hospital, Maputo, Mozambique. 10. National Cancer Control Programme, Ministry of Health, Maputo, Mozambique. 11. Patologia e Oncologia, Faculdade de Medicina, da Universidade do Porto, Porto, Portugal. 12. Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal. 13. Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal. 14. Surgical, Maputo Central Hospital, Maputo, Mozambique. 15. Radiotherapy, Maputo Central Hospital, Maputo, Mozambique.
Abstract
BACKGROUND: Despite the international endorsement of multidisciplinary tumor boards (MTBs) for breast cancer care, implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. We assessed the impact on survival and the cost-effectiveness of implementing an MTB in Mozambique, sub-Saharan Africa. MATERIALS AND METHODS: This prospective cohort study included 205 patients with breast cancer diagnosed between January 2015 and August 2017 (98 before and 107 after MTB implementation), followed to November 2019. Pre- and post-MTB implementation subcohorts were compared for clinical characteristics, treatments, and overall survival. We used hazard ratios and 95% confidence intervals (CI), computed by Cox proportional hazards regression. The impact of MTB implementation on the cost per quality-adjusted life year (QALY) was estimated from the provider perspective. RESULTS: We found no significant differences between pre- and post-MTB subcohorts regarding clinical characteristics or treatments received. Among patients with early breast cancer (stage 0-III; n = 163), the 3-year overall survival was 48.0% (95% CI, 35.9-59.1) in the pre-MTB and 73.0% (95% CI, 61.3-81.6) in the post-MTB subcohort; adjusted hazard ratio, 0.47 (95% CI, 0.27-0.81). The absolute 3-year mean cost increase was $119.83 per patient, and the incremental cost-effectiveness ratio was $802.96 per QALY, corresponding to 1.6 times the gross domestic product of Mozambique. CONCLUSION: The implementation of a MTB in Mozambique led to a 53% mortality decrease among patients with early breast cancer, and it was cost-effective. These findings highlight the feasibility of implementing this strategy and the need for scaling-up MTBs in developing countries, as a way to improve patient outcomes. IMPLICATIONS FOR PRACTICE: Currently, more than half of the deaths from breast cancer in the world occur in developing countries. Strategies that optimize care and that are adjusted for available resources are needed to improve the outcomes of patients with breast cancer in these regions. The discussion of cases at multidisciplinary tumor boards (MTBs) may improve survival outcomes, but implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. This study evaluated the impact of implementing an MTB on the care and survival of patients with breast cancer in Mozambique, sub-Saharan Africa and its cost-effectiveness in this low-income setting.
BACKGROUND: Despite the international endorsement of multidisciplinary tumor boards (MTBs) for breast cancer care, implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. We assessed the impact on survival and the cost-effectiveness of implementing an MTB in Mozambique, sub-Saharan Africa. MATERIALS AND METHODS: This prospective cohort study included 205 patients with breast cancer diagnosed between January 2015 and August 2017 (98 before and 107 after MTB implementation), followed to November 2019. Pre- and post-MTB implementation subcohorts were compared for clinical characteristics, treatments, and overall survival. We used hazard ratios and 95% confidence intervals (CI), computed by Cox proportional hazards regression. The impact of MTB implementation on the cost per quality-adjusted life year (QALY) was estimated from the provider perspective. RESULTS: We found no significant differences between pre- and post-MTB subcohorts regarding clinical characteristics or treatments received. Among patients with early breast cancer (stage 0-III; n = 163), the 3-year overall survival was 48.0% (95% CI, 35.9-59.1) in the pre-MTB and 73.0% (95% CI, 61.3-81.6) in the post-MTB subcohort; adjusted hazard ratio, 0.47 (95% CI, 0.27-0.81). The absolute 3-year mean cost increase was $119.83 per patient, and the incremental cost-effectiveness ratio was $802.96 per QALY, corresponding to 1.6 times the gross domestic product of Mozambique. CONCLUSION: The implementation of a MTB in Mozambique led to a 53% mortality decrease among patients with early breast cancer, and it was cost-effective. These findings highlight the feasibility of implementing this strategy and the need for scaling-up MTBs in developing countries, as a way to improve patient outcomes. IMPLICATIONS FOR PRACTICE: Currently, more than half of the deaths from breast cancer in the world occur in developing countries. Strategies that optimize care and that are adjusted for available resources are needed to improve the outcomes of patients with breast cancer in these regions. The discussion of cases at multidisciplinary tumor boards (MTBs) may improve survival outcomes, but implementation is suboptimal worldwide, and evidence regarding their effectiveness in developing countries is lacking. This study evaluated the impact of implementing an MTB on the care and survival of patients with breast cancer in Mozambique, sub-Saharan Africa and its cost-effectiveness in this low-income setting.
Authors: E Pons-Tostivint; L Daubisse-Marliac; P Grosclaude; E Oum Sack; J Goddard; C Morel; C Dunet; L Sibrac; C Lagadic; E Bauvin; Y Bergé; C Bernard-Marty; C Vaysse; J L L Lacaze Journal: Breast Date: 2019-06-07 Impact factor: 4.380
Authors: Cesaltina F Lorenzoni; Josefo Ferro; Carla Carrilho; Murielle Colombet; Donald M Parkin Journal: Int J Cancer Date: 2020-03-18 Impact factor: 7.396
Authors: E J Kantelhardt; P Zerche; A Mathewos; P Trocchi; A Addissie; A Aynalem; T Wondemagegnehu; T Ersumo; A Reeler; B Yonas; M Tinsae; T Gemechu; A Jemal; C Thomssen; A Stang; S Bogale Journal: Int J Cancer Date: 2014-01-10 Impact factor: 7.396
Authors: Wilfred Ngwa; Beatrice W Addai; Isaac Adewole; Victoria Ainsworth; James Alaro; Olusegun I Alatise; Zipporah Ali; Benjamin O Anderson; Rose Anorlu; Stephen Avery; Prebo Barango; Noella Bih; Christopher M Booth; Otis W Brawley; Jean-Marie Dangou; Lynette Denny; Jennifer Dent; Shekinah N C Elmore; Ahmed Elzawawy; Diane Gashumba; Jennifer Geel; Katy Graef; Sumit Gupta; Serigne-Magueye Gueye; Nazik Hammad; Laila Hessissen; Andre M Ilbawi; Joyce Kambugu; Zisis Kozlakidis; Simon Manga; Lize Maree; Sulma I Mohammed; Susan Msadabwe; Miriam Mutebi; Annet Nakaganda; Ntokozo Ndlovu; Kingsley Ndoh; Jerry Ndumbalo; Mamsau Ngoma; Twalib Ngoma; Christian Ntizimira; Timothy R Rebbeck; Lorna Renner; Anya Romanoff; Fidel Rubagumya; Shahin Sayed; Shivani Sud; Hannah Simonds; Richard Sullivan; William Swanson; Verna Vanderpuye; Boateng Wiafe; David Kerr Journal: Lancet Oncol Date: 2022-05-09 Impact factor: 54.433