Cost-effectiveness evaluation of risk-based breast cancer screening in Urban Hebei Province

Abstract

To evaluate the implementations of Cancer Screening Program in Urban Hebei and to model the cost-effectiveness of a risk-based breast Cancer Screening Program. Women aged 40–74 years were invited to participate the Cancer Screening Program in Urban Hebei form 2016 to 2020 by completing questionnaires to collect information about breast cancer exposure. Clinical screening including ultrasound and mammography examination were performed. We developed a Markov model to estimate the lifetime costs and benefits, in terms of quality-adjusted life years (QALY), of a high-risk breast Cancer Screening Program. Nine screening strategies and no screening were included in the study. The age-specific incidence, transition probability data and lifetime treatment costs were derived and adopted from other researches. Average cost-effectiveness ratios (ACERs) were estimated as the ratios of the additional costs of the screening strategies to the QLYG compared to no screening. Incremental cost-effectiveness ratios (ICERs) were calculated based on the comparison of a lower cost strategies to the next more expensive and effective strategies after excluding dominated strategies and extendedly dominated strategies. ICERs were used to compare with a willingness-to-pay (WTP) threshold. Sensitivity analysis was explored the influence factors. A total of 84,029 women completed a risk assessment questionnaire, from which 20,655 high-risk breast cancer females were evaluated, with a high-risk rate of 24.58%. There were 13,392 high-risk females completed the screening program, with participation rate was 64.84%. Undergoing ultrasound, mammography and combined screening, the suspicious positive detection rates were 15.00%, 9.20% and 19.30%, and the positive detection rates were 2.11%, 2.76% and 3.83%, respectively. According to the results by Markov model, at the end of 45 cycle, the early diagnosis rates were 55.53%, 60.68% and 62.47% underwent the annual screening by ultrasound, mammography and combined, the proportion of advanced cancer were 17.20%, 15.85% and 15.36%, respectively. Different screening method and interval yield varied. In the exploration of various scenarios, annual ultrasound screening is the most cost-effective strategy with the ICER of ¥116,176.15/QALY. Sensitivity analyses demonstrated that the results are robust. Although it was not cost effective, combined ultrasound and mammography screening was an effective strategy for higher positive detection rate of breast cancer. High-risk population-based breast cancer screening by ultrasound annually was the most cost-effective strategy in Urban Hebei Province.

Profiles and Findings of Population-Based Esophageal Cancer Screening With Endoscopy in China: Systematic Review and Meta-analysis

“…Second, for community servers in population-based EC screening, more attention and interventions should be paid to several vulnerable populations in health literacy to improve their compliance rate with endoscopic examinations. These populations included males, cigarette smokers, and those with low socioeconomic status, who had a higher risk of developing EC but lower compliance rates of endoscopic examinations, as observed in previous population-based EC screening studies [31,33,79]. In addition, optimization of the screening procedure, such as shortening the waiting time for endoscopic examinations, may be considered another effective measure to improve compliance, as indicated in population-based cancer screening programs [80].…”

“…The characteristics of the 66 included studies are outlined in Table S4 of Multimedia Appendix 1, and the summary characteristics about reporting compliance with endoscopy examinations and endoscopy findings are summarized in Table 1 and Table 2, A total of 2,472,920 asymptomatic individuals were included in 31 studies that reported compliance with endoscopy examinations, one of which reported data from both rural and urban China [11]. Therefore, 2,006,235 individuals were from high-risk areas during 1999-2017 (n=12) [6,10,[12][13][14][15][16][17][18][19][20][21], 125,473 individuals were from rural China during 2010-2017 (n=2) [11,22], and 341,212 individuals were from urban China during 2012-2019 (n=18) [11,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39], as shown in Table 1 and Table S4 of Multimedia Appendix 1. The details of the high-risk assessment strategy to select targets to undergo further endoscopy screening are summarized in Table S5 of Multimedia Appendix 1.…”

“…Therefore, a total of 876,170 individuals aged 40-69 years (n=36 studies)[6,11,12,[14][15][16][17] from high-risk areas underwent endoscopic examinations, where a universal endoscopy strategy was adopted. A total of 102,413 individuals with a high risk of EC (n=4 studies)[11,[69][70][71] aged 40-69 years in rural China and 18,421 individuals with a high risk of EC/UGI cancer (n=6 studies)[11,29,33,[72][73][74] aged 40-74 years in urban China underwent endoscopic examinations where the RSES strategy was adopted (Table2). The number of individual study samples ranged from 1151[74] to 116,630[67] across all included studies.…”

Evaluating the Role of Breast Ultrasound in Early Detection of Breast Cancer in Low- and Middle-Income Countries: A Comprehensive Narrative Review

“…Ultrasound machines are comparatively more cost-effective and portable than mammography or magnetic resonance imaging (MRI) machines, considering their initial price and infrastructure requirements. The price of breast ultrasonography improves the practicality of including it in screening programs, particularly in places with low resources, hence guaranteeing wider availability of early detection techniques [ 16 , 18 , 19 , 26 , 45 ].…”

Comparing the cost-benefit of breast cancer screening programs in rural and urban areas across four economic zones in China: a Markov modeling analysis

“…This had resulted in insu cient evidence for policy recommendations. 5,[8][9][10] Breast cancer screening might be cost-effective in a Chinese setting for two reason. First, screening could detect patients early, enabling them to receive effective treatment and avoid serious health outcomes and cost expenditures.…”