Assessment of the Benefits and Cost-Effectiveness of Population-Based Breast Cancer Screening in Urban China: A Model-Based Analysis

Abstract

Background: To decrease the burden of breast cancer (BC), the Chinese government recently introduced biennial mammography screening for women aged 45-70 years. In this study, we assess the effectiveness and cost-effectiveness of implementing this programme in urban China using a micro-simulation model. Methods: The 'Simulation Model on radiation Risk and breast cancer Screening' (SiMRiSc) was applied, with parameters updated based on available data for the Chinese population. The base scenario was biennial mammography screening for women aged 45-70 years, and this was compared to a reference population with no screening. Seven alternative scenarios were then simulated by varying the screening intervals and participant ages. This analysis was conducted from a societal perspective. The discounted incremental cost-effectiveness ratio (ICER) was compared to a threshold of triple the gross domestic product (GDP) per life years gained (LYG), which was 30 785 USD/LYG. Univariate sensitivity analyses were conducted to evaluate model robustness. In addition, a budget impact analysis was performed by comparing biennial screening with no screening at a time horizon of 10 years. Results: Compared with no screening, the base scenario was cost-effective in urban China, giving a discounted average cost-effectiveness ratio (ACER) of 17 309 USD/LYG. The model was most sensitive to the cost of mammography per screen, followed by mean size of self-detected tumours, mammographic breast density and the cumulative lifetime risk of BC. The efficient frontier showed that at a threshold of 30 785 USD/LYG, the base scenario was the optimal scenario with a discounted ICER of 25 261 USD/LYG. Over 10 years, screening would incur a net cost of almost 38.1 million USD for a city with 1 million citizens. Conclusion:Compared to no screening, biennial mammography screening for women aged from 45-70 is cost-effective in urban China.

Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review

“…Furthermore, Souza et al [ 39 ] revealed that biennial screen-filmed mammography is more economically viable than annual screening (both strategies were cost-effective). Wang et al [ 28 ] found that biennial mammography (45-70 years) is more cost-effective than triennial mammography (45-70 years). Ulloa-Perez et al [ 36 ] reported that mammography screening approaches cost-saving only if the screening interval is biennial or triennial (40-70 years).…”

“…Coverage rate was also evaluated by studies included in this review. Wang et al [ 28 ] evaluated coverage of 100%, 80%, or 60%; Ginsberg et al [ 42 ] assessed coverage of 50%, 80%, or 90%; Gonzales Marino et al [ 45 ] used coverage of larger than 50%; Valencia-Mendoza et al [ 46 ] evaluated coverage of 25% and 50%. The results were varied as presented in Table 4 .…”

“…Among all 21 studies from LMICs, 16 studies were from Upper MICs, 3 studies were from Lower MICs, and 2 studies were from both MIC and Low-Income Countries (LICs). We found nine studies from Asia [28][29][30][31][32]34,35,37,47], two studies from Africa [43,48], one study from both Africa and Asia (undetermined which country) [42], five studies from South America [39][40][41]44,45], two studies from North America [36,46], one study from both South and North America (Mexico and Costa Rica) [38], and one study from Europe (Turkey) [33]. Reviewed studies were based on either mathematical models (n = 18) or empirical data (n = 3).…”

“…The quality of all studies ranged from 40% to 95%. 11 studies were categorized as good quality [28,30,33,38,[39][40][41][42][43]47,48], seven as moderate quality [29,31,32,34,35,46], and three as low quality [36,44,45].…”

Advances in breast cancer screening modalities and status of global screening programs

“…Several studies have shown that organized mammographic screening at biennial intervals can be cost‐effective. 69 , 70 , 71 , 72 A study conducted by Wang et al 73 used a microsimulation model to assess the cost‐effectiveness of implementing biennial mammographic screening for women aged 45–70 years in urban China. The results showed that compared to no screening and seven other alternative scenarios, biennial mammographic screening was the most cost‐effective strategy, with a discounted incremental cost‐effectiveness ratio (ICER) of US$25,261 per life‐year gained.…”