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Cost‐effectiveness of breast cancer screening programme for women in rural China
Author(s) -
Sun Li,
Sadique Zia,
dosSantosSilva Isabel,
Yang Li,
Legood Rosa
Publication year - 2018
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.31956
Subject(s) - medicine , breast cancer , breast cancer screening , mammography , cost effectiveness , asymptomatic , quality adjusted life year , gynecology , rural area , cancer , obstetrics , surgery , pathology , risk analysis (engineering)
In low and middle‐income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35–64 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost‐effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non‐screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one‐way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality‐adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost‐effectiveness ratio (ICER) of $‐916/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost‐effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.

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