Evidence map›Paper›PMID 39900428›Full record

ArticleBMJ global health2025

Modelling the health, financial protection and equity impacts of upscaling the ACT NOW early intervention breast cancer pilot program in the Philippines: an extended cost-effectiveness analysis.

Alexander Chye, Stephen Jan, Nirmala Bhoo Pathy, Herdee Gloriane C Luna, Soledad B Lim, Merel Kimman, Mark Woodward, Sanne Peters, Helen Monaghan, Corazon A Ngelangel and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Alexander ChyeThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia achye@georgeinstitute.org.au.ORCID http://orcid.org/0000-0001-8379-371X
Stephen JanThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Nirmala Bhoo PathyCentre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Herdee Gloriane C LunaACT NOW Breast Cancer Early Detection, Philippine Cancer Society, Manila, Philippines.
Soledad B LimJose R Reyes Memorial Medical Center, Department of Health, Manila, Philippines.
Merel KimmanDepartment of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
Mark WoodwardThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Sanne PetersSchool of Public Health, The George Institute for Global Health UK, Imperial College London, London, UK.
Helen MonaghanThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Corazon A Ngelangel *University of the Philippines Manila, College of Medicine, Manila, Philippines.
Blake Angell *The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-7188-7740

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWomen in the Philippines experience significant health and economic burdens of breast cancer. The Philippines has reformed financial protection for breast cancer but does not have a national early detection and treatment programme. This study aims to model the health and economic impacts of ACT NOW (a pilot breast cancer programme that navigates women through free early detection to treatment) through an extended cost-effectiveness analysis.

methodsA microsimulation decision tree model was used to model the ACT NOW intervention (including annual clinical breast examination (CBE) and biannual breast ultrasound for women at high risk of breast cancer) over 5 years for healthy women 40-69 years old. Outcomes included health gains (breast cancer deaths saved), financial protection (financial catastrophes saved) and incremental cost-effectiveness ratios (ICER) (cost per disability-adjusted life year (DALY) saved). Outcomes were stratified by income group. Probabilistic, one-way sensitivity and scenario analyses explored uncertainty.

resultsOver 5 years, the ACT NOW intervention is cost-effective with an ICER of PHP60 711 (USD1098) (average incremental cost PHP743 [95% UI 424-960] and DALYs saved 0.01 [95% UI 0.01-0.02], below Philippines 2022 gross domestic product per capita PHP178 751). Per 100 000 women, 57 deaths and eight financial catastrophes were saved. Cost-effectiveness did not vary significantly by income, but higher income groups incurred greater costs and lower DALYs. Results were sensitive to proportion of late-stage breast cancers post intervention, treatment adherence, intervention costs and downstaging effectiveness. Trade-offs are apparent between government contributions to financial protection and rates of financial catastrophe.

conclusionsEarly detection interventions (annual CBE, biannual breast ultrasound if at high risk of breast cancer) are likely to be cost-effective, reduce breast cancer-related mortality through detection at earlier stages and modestly effective in reducing the incidence of financial catastrophe. Further research is required to establish the best implementation model to pursue full implementation and ways of designing equity-based screening interventions.

Indexed as

Breast NeoplasmsEarly Detection of CancerAdultAgedCost-Benefit AnalysisCost-Effectiveness AnalysisDecision TreesFemaleHumansMiddle AgedPhilippinesPilot ProjectsCancerGlobal HealthHealth economicsHealth policyHealth services research

Identifiers

PMID39900428
PMCPMC11795370

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.