Zhou Dachuang, Zhou Kejia, Wang Wenjuan, Shao Hanqiao, Zhang Hongliu, Tang Wenxi
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
Department of Public Affairs Management, School of International Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China.
BMC Public Health. 2025 Jan 21;25(1):256. doi: 10.1186/s12889-024-20867-1.
This study assessed the effectiveness and cost-effectiveness of breast cancer screening across rural and urban regions in China's four economic zones.
Using a decision-analytic Markov model, we evaluated 5,280 scenarios involving different ages and screening technologies. The model followed individuals from birth through 100 yearly cycles in eight settings. Model parameters, such as incidence, transition rate, attendance and compliance rate, screening accuracy, utility, and mortality, were based on Chinese research and international data. Screening costs were calculated using median medical costs in the respective zones. The main outcome measured was incremental net benefit (INB) and incremental cost-effectiveness ratio (ICER), with sensitivity analyses to assess uncertainty.
Using a willingness-to-pay threshold of three times the local per capita Gross domestic product (GDP), the recommended strategies varied across regions. However, annual screening of individuals aged 30-70 years with a combination of mammography (MAM) and computed tomography laser mammography (CTL) was the most cost-effective strategy for most regions. The incremental cost-effectiveness ratios (ICERs) of the most cost-effective strategies, compared to no intervention and status quo in China, ranged from US$5,173.31/QALY to US$18,551.27/QALY, and from US$-3,872.28 to US$17,804.59, respectively. Except for the rural central region, where the cost-effective strategy had suboptimal outcomes compared to status quo, the recommended strategies in the other seven regions could prevent 41.12-58.80% and 8.08-35.39% of advanced breast cancer cases, and 18.83-29.27% and 2.71-14.06% of breast cancer deaths, when compared to no screening and status quo, respectively. Sensitivity analysis indicated that the results were robust.
Our study identified cost-effective breast cancer screening strategies suitable for the rural and urban areas in China's four major economic zones. These findings highlight the necessity of universal screening and the importance of optimizing strategies based on regional economic development and epidemiological characteristics. These insights are crucial for improving national breast cancer screening policies.
本研究评估了中国四个经济区城乡地区乳腺癌筛查的有效性和成本效益。
我们使用决策分析马尔可夫模型，评估了5280种涉及不同年龄和筛查技术的情景。该模型跟踪个体从出生到100个年度周期，涵盖八个场景。模型参数，如发病率、转移率、参与率和依从率、筛查准确性、效用和死亡率，均基于中国研究和国际数据。筛查成本使用各地区的医疗费用中位数计算。主要测量结果是增量净效益（INB）和增量成本效益比（ICER），并进行敏感性分析以评估不确定性。
使用当地人均国内生产总值（GDP）三倍的支付意愿阈值，推荐策略因地区而异。然而，对30 - 70岁个体每年联合使用乳腺钼靶（MAM）和计算机断层扫描激光乳腺成像（CTL）进行筛查，是大多数地区最具成本效益的策略。与中国不干预和现状相比，最具成本效益策略的增量成本效益比（ICER）分别为5173.31美元/质量调整生命年至18551.27美元/质量调整生命年，以及 - 3872.28美元至17804.59美元。除农村中部地区外，与现状相比，该地区具有成本效益的策略效果次优，其他七个地区的推荐策略与不筛查和现状相比，分别可预防41.12% - 58.80%和8.08% - 35.39%的晚期乳腺癌病例，以及18.83% - 29.27%和2.71% - 14.06%的乳腺癌死亡。敏感性分析表明结果具有稳健性。
我们的研究确定了适合中国四大经济区城乡地区的具有成本效益的乳腺癌筛查策略。这些发现凸显了普遍筛查的必要性以及根据区域经济发展和流行病学特征优化策略的重要性。这些见解对于完善国家乳腺癌筛查政策至关重要。
