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.