Abstract
BackgroundWe aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control.MethodsA state-transition Markov model simulated a hypothetical cohort of 100,000 healthy women, the start aged was set at 35 years and the time horizon was set to 50 years. The primary outcome for the model was the incremental cost-utility ratio (ICUR), defined as the program’s cost per quality-adjusted life year (QALY) gained. Three screening strategies providing by community health service for women aged 35 to 69 years was compared regarding to different intervals.ResultThe probability of the ICUR being below 20 272USD (i.e., triple the annual gross domestic product [3 GDPs]) per QALY saved was 100% for annual screening strategy and screening every three years. Only when the attendance rate was > 50%, the probability for annual screening would be cost effective > 95%. The probability for the annual screening strategy being cost effective could reach to 95% for a willingness-to-pay (WTP) of 2 GDPs when the compliance rate for transfer was > 80%. When 10% stage I tumors were detected by screening, the probability of the annual screening strategy being cost effective would be up to 95% for a WTP > 3 GDPs.ConclusionAnnual community-based breast cancer screening was cost effective for a WTP of 3 GDP based on the incidence of breast cancer in Tianjin, China. Measures are needed to ensure performance indicators to a desirable level for the cost-effectiveness of breast cancer screening.
Highlights
We aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control
Annual community-based breast cancer screening was cost effective for a WTP of 3 Gross domestic product (GDP) based on the incidence of breast cancer in Tianjin, China
There is a growing need to develop approaches that reflect the relationships between performance indicators and the feasibility of a screening strategy
Summary
We aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control. Breast cancer screening by populationbased mammography (MAM) has been proven to reduce. There is no nationwide screening program for breast cancer in China at present [1], population-based studies of CBE combined with diagnostic USG, MAM, or both are currently in progress [1, 8]. Local governments have sponsored community-based breast cancer screening programs in several urban cities despite doubts about the efficacy of CBE for early detection in diverse Chinese populations. A population-based study of these breast cancer screening programs provided good performance results, with a sensitivity and specificity. Breast cancer screening, especially when using CBE, may not be as effective in clinical settings as it is in trial settings [10]
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