Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 9 2022 09 01 Assessment of the Benefits and Cost-Effectiveness of Population-Based Breast Cancer Screening in Urban China: A Model-Based Analysis 1658 1667 4071 10.34172/ijhpm.2021.62 EN Jing Wang Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 0000-0001-8634-7942 Marcel J.W. Greuter Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands Senshuang Zheng Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Daniëlle W.A. Van Veldhuizen Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Karin M. Vermeulen Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Yuan Wang Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China Wenli Lu Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China 0000-0003-2894-7506 Geertruida H. De Bock Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Journal Article 2020 09 08 Background To decrease the burden of breast cancer (BC), the Chinese government recently introduced biennial mammography screening for women aged 45-70 years. In this study, we assess the effectiveness and cost-effectiveness of implementing this programme in urban China using a micro-simulation model. Methods The ‘Simulation Model on radiation Risk and breast cancer Screening’ (SiMRiSc) was applied, with parameters updated based on available data for the Chinese population. The base scenario was biennial mammography screening for women aged 45-70 years, and this was compared to a reference population with no screening. Seven alternative scenarios were then simulated by varying the screening intervals and participant ages. This analysis was conducted from a societal perspective. The discounted incremental cost- effectiveness ratio (ICER) was compared to a threshold of triple the gross domestic product (GDP) per life years gained (LYG), which was 30 785 USD/LYG. Univariate sensitivity analyses were conducted to evaluate model robustness. In addition, a budget impact analysis was performed by comparing biennial screening with no screening at a time horizon of 10 years. Results Compared with no screening, the base scenario was cost-effective in urban China, giving a discounted average cost-effectiveness ratio (ACER) of 17 309 USD/LYG. The model was most sensitive to the cost of mammography per screen, followed by mean size of self- detected tumours, mammographic breast density and the cumulative lifetime risk of BC. The efficient frontier showed that at a threshold of 30 785 USD/LYG, the base scenario was the optimal scenario with a discounted ICER of 25 261 USD/LYG. Over 10 years, screening would incur a net cost of almost 38.1 million USD for a city with 1 million citizens. Conclusion Compared to no screening, biennial mammography screening for women aged from 45-70 is cost-effective in urban China.

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