Cost-effectiveness of two major population-based breast cancer screening programmes in China: a model-based economic evaluation.

INTRODUCTION: Chinese women face a rising burden of breast cancer and require effective screening strategies suitable for a developing-country context. However, the cost-effectiveness of national breast cancer screening programmes in China remains unclear. METHODS: A hybrid decision tree-Markov model simulated lifetime costs and outcomes for 100 000 women aged 30-80 years from a societal perspective under rural and urban screening settings. Screening effectiveness was derived from national multicentre data and regional meta-analyses, with costs based on national surveys and multicentre treatment estimates. Parameter uncertainties were evaluated using deterministic and probabilistic sensitivity analyses. RESULTS: The incremental cost per quality adjusted life year (QALY) gained ranged from US$0.04 to US$0.07 million for Cervical Cancer and Breast Cancer Screening Programme for Women-Breast Cancer (CCBCSPW-BC) and US$0.08 to US$0.13 million for Cancer Screening Programme in Urban Areas-Breast Cancer (CanSPUA-BC) across screening frequencies. At current utilisation levels, neither programme was cost-effective at willingness-to-pay thresholds of one or three times China's per capita gross domestic product although CCBCSPW-BC demonstrated better economic performance. Scenario analysis showed that if referral compliance increased to ≥70% in rural settings or ≥80% in urban settings, CCBCSPW-BC screening every 3-5 years could meet cost-effectiveness thresholds. CONCLUSION: Under current implementation conditions, neither programme is cost-effective. Improving referral compliance is a key barrier to enhancing screening effectiveness. Strengthening targeting strategies and optimising screening pathways will be critical to balance overdiagnosis and missed detection in future screening practice.