Cost-benefit analysis of mammography screening: the perspective of Nigerian healthcare providers.

Introduction: There is no national breast cancer screening implemented in Nigeria. The National Cancer Control Plan (NCCP) has a goal of making screening services and early detection of cancer available for all Nigerians. Health financing is predominantly through out-of-pocket (OOP) spending. As it could take a while for the NCCP to figure out a financing mechanism to make screening widely available, it is necessary to assess if mammography screening could be potentially funded by OOP by ascertaining the value that eligible women place on it. This study assessed the cost-benefit of mammography screening from the healthcare provider's perspective. Methods: This hospital-based cross-sectional study assessed the potential benefit of mammography using participants' willingness to pay (WTP) for the service. Average WTP was determined using contingent valuation. Binary logistic regression was used to assess predictors of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. The cost of mammography was estimated from the healthcare provider's perspective. Probabilistic sensitivity analysis was used to account for parameter uncertainty. The benefit-cost ratio (BCR) was calculated. Results: 767 respondents participated in the study. The stated average WTP amount (minimum-maximum) was US$10.26 (US$0.0-US$46.20). Participants who had never noticed a breast change were 2.5 times more likely to be willing to pay for mammography screening. A unit increase in income level led to a US$9.185 increase in WTP amount for mammography screening. Also, a unit increase in breast self-examination led to a US$2.797 increase in WTP amount for mammography screening. The average cost (minimum-maximum) of mammography was US$23.02 (US$13.20-US$33.00). The BCR of mammography screening was 0.45 (95% CI 0.44 to 0.46). Conclusions: Mammography screening is not cost-beneficial to the healthcare provider when clients are asked to pay OOP. This highlights the need to explore sustainable health financing mechanisms to support mammography screening in Nigeria.