Decision modelling of economic evaluation of intervention programme of breast cancer Jung-Chen Chang PhD, 1 Tony H-H. Chen PhD, 2 Stephen W. Duffy MS, 3 Amy M-F. Yen PhD 4 and Sam L-S. Chen PhD 5 1 Associate Professor, Department of Geriatric Health Promotion, College of Healthcare Management, Kainan University, Taoyuan County, Taiwan 2 Professor, Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan, Professor, Centre of Biostatistical Consultation, College of Public Health, National Taiwan University, Taipei, Taiwan and Professor, Tampere School of Public Health, Tampere, Finland 3 Professor, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, London, UK 4 Research Fellow, Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan and Adjunct Assistant Professor, Centre of Biostatistical Consultation, College of Public Health, National Taiwan University, Taipei, Taiwan 5 Research Fellow, Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan, Research Fellow, Centre of Biostatistical Consultation, College of Public Health, National Taiwan University, Taipei, Taiwan and Deputy Director, Laboratory of Biostatistics, Changhua Christian Hospital, Changhua, Taiwan Keywords breast cancer, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, decision model, Markov model, probabilistic approach Correspondence Professor Tony H-H. Chen Division of Biostatistics Graduate Institute of Epidemiology College of Public Health National Taiwan University Room 540, no. 17, Hsuchow Rd Taipei Taiwan /Tampere School of Public Health University of Tampere Tampere 33520 Finland E-mail: chenlin@ntu.edu.tw Accepted for publication: 10 August 2009 doi:10.1111/j.1365-2753.2009.01329.x Abstract Objectives Economic appraisal of an intervention is a complex and multivariable problem, with probabilistic issues related not only to clinical outcomes but also to costs and will- ingness to pay. Methods We provide a comprehensive framework for economic appraisal of a health intervention to prevent beast cancer mortality, involving probabilistic model of costs as well as of aspects of the disease process. The economic appraisal can give a range of probabili- ties of cost-effectiveness depending on willingness or ability to pay. Results We apply the method to the example of polychemotherapy for early breast cancer. Results indicate a 30% probability of cost-effectiveness for a willingness to pay of $60 000 per quality-adjusted life-year and around 50% for a threshold of $100 000. Conclusion The comprehensive economic appraisal model is a powerful tool for decision making over a range of economic environments. Introduction Decision making for the prevention of breast cancer mortality in the light of evidence-based medicine has increasingly gained attention for health policy-makers. In economically developed countries, in addition to the popularity of mammographic screen- ing supported by randomized controlled trials since 1970 [1–4], expectations for early detection of breast cancer have been raised by the advent of other techniques such as ultrasonography, mag- netic resonance imaging (MRI), digital mammography [5–12]. In addition, there are decision issues relating to adjuvant therapy [13]. From the health administration viewpoint, the choice of breast cancer control strategies has to take into account costs as well as potential benefits. In moderately or poorly developed coun- tries, health policymakers are under considerable pressure, given the scarce resources and competing interventions, often resulting from evidence-based studies in developed countries. The question which often arises is: ‘What extra cost should be invested early in a new adjuvant therapy or in early detection per additional life year saved?’ Journal of Evaluation in Clinical Practice ISSN 1356-1294 © 2010 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 16 (2010) 1282–1288 1282