Cost Effectiveness Of Urban Breast Cancer Screening Programme In China

Abstract

This study aimed to analyse the cost-effectiveness of the breast cancer screening pilot program among urban Chinese women, as well as to conduct sensitivity analysis, scenario analysis, and the budget impact analysis. A Markov model was developed from a societal perspective among asymptomatic Chinese women over 40 years at risk for breast cancer over a lifetime horizon in urban China. We obtained the incremental cost-effectiveness ratio (ICER) and explored the uncertainty using one-way and probabilistic sensitivity analysis. We also explored the ICERs in different geographic areas and cities as well as with different screening intervals and population coverage. In the budget impact analysis, we analysed the screening funding to detect one case in the program, and the impact of the issued questionnaires’ number on the screening funding. The ICER of screening was ¥-3195/QALY in the urban programme. Compared to no screening, breast screening was cost-saving in all levels of cities and all geographic areas in China. Also, the results did not change with screening intervals. When the population coverage increased, the breast screening was more cost-saving. The treatment costs, the screening costs, and the effectiveness of the screening methods can influence the ICERs but they did not change the results. At the threshold of ¥140000/QALY, the probability of breast screening being cost-effective compared to no screening in urban areas was almost 100%. The budget impact analysis showed that the screening cost was ¥17806 to detect one case in the urban program. If the number of issued questionnaires reached the target, the screening cost for one detected case was only ¥7122. The urban breast cancer screening program in China was effective and cost-saving. We recommend to expand the population coverage and to ensure that the issued questionnaires reach the target quantity.