Sun L, Legood R, Sadique Z, dos-Santos-Silva I, Yang L. Cost-effectiveness of risk-based breast cancer screening programme, China.
Bull World Health Organ 2018;
96:568-577. [PMID:
30104797 PMCID:
PMC6083393 DOI:
10.2471/blt.18.207944]
[Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE
To model the cost-effectiveness of a risk-based breast cancer screening programme in urban China, launched in 2012, compared with no screening.
METHODS
We developed a Markov model to estimate the lifetime costs and effects, in terms of quality-adjusted life years (QALYs), of a breast cancer screening programme for high-risk women aged 40-69 years. We derived or adopted age-specific incidence and transition probability data, assuming a natural history progression between the stages of cancer, from other studies. We obtained lifetime direct and indirect treatment costs in 2014 United States dollars (US$) from surveys of breast cancer patients in 37 Chinese hospitals. To calculate QALYs, we derived utility scores from cross-sectional patient surveys. We evaluated incremental cost-effectiveness ratios for various scenarios for comparison with a willingness-to-pay threshold.
FINDINGS
Our baseline model of annual screening yielded an incremental cost-effectiveness ratio of US$ 8253/QALY, lower than the willingness-to-pay threshold of US$ 23 050/QALY. One-way and probabilistic sensitivity analyses demonstrated that the results are robust. In the exploration of various scenarios, screening every 3 years is the most cost-effective with an incremental cost-effectiveness ratio of US$ 6671/QALY. The cost-effectiveness of the screening is reduced if not all diagnosed women seek treatment. Finally, the economic benefit of screening women aged 45-69 years with both ultrasound and mammography, compared with mammography alone, is uncertain.
CONCLUSION
High-risk population-based breast cancer screening is cost-effective compared with no screening.
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