Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
School of Public Health, Peking University, Beijing, China.
Int J Cancer. 2019 May 15;144(10):2596-2604. doi: 10.1002/ijc.31956. Epub 2018 Dec 8.
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.
在中低收入国家，乳腺 X 线照相术乳腺癌筛查费用过高，因此需要一种更廉价的替代方案，即使用超声作为主要筛查手段。2009 年，中国启动了针对农村地区 35-64 岁女性的乳腺癌筛查计划，采用临床乳房检查和超声作为主要筛查工具。我们的研究旨在分析与不筛查相比，乳腺筛查在中国农村女性中的成本效益。我们开发了一个马尔可夫模型，从社会角度来估计 35 岁农村女性的终生成本和效果。干预组中的无症状女性在 64 岁之前每 3 年接受一次筛查。非筛查组中的乳腺癌只能在出现症状时诊断。使用单因素和概率敏感性分析来探讨参数不确定性。与不筛查相比，乳腺筛查的成本增加了 186.7 美元，导致健康相关生命质量调整年数（QALYs）损失了 0.20。乳腺筛查在农村女性中更昂贵且对健康有害，增量成本效益比（ICER）为-916 美元/QALY。敏感性分析确定假阳性引起的效用损失是影响结果的最重要因素，但这并没有改变结论。在这种乳腺癌发病率如此低的农村环境中，使用当前的筛查工具对无症状疾病进行筛查没有成本效益。应优先确保有症状的女性能够及早获得适当的诊断和治疗，因为这将在没有常规筛查危害的情况下降低死亡率。
