Jing Wang - Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Marcel Greuter - Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Senshuang Zheng - Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Daniëlle van Veldhuizen - Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Karin 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
Wenli Lu - Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
Geertruida H. de Bock - Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Background  To decrease the burden of breast cancer (BC), the Chinese government recently introduced biennial mammography screening for women aged ۴۵-۷۰ 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 ۴۵-۷۰ 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 ۳۰ ۷۸۵ 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 ۱۰ years.Results  Compared with no screening, the base scenario was cost-effective in urban China, giving a discounted average cost-effectiveness ratio (ACER) of ۱۷ ۳۰۹ 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 ۳۰ ۷۸۵ USD/LYG, the base scenario was the optimal scenario with a discounted ICER of ۲۵ ۲۶۱ USD/LYG. Over ۱۰ years, screening would incur a net cost of almost ۳۸.۱ million USD for a city with ۱ million citizens. Conclusion  Compared to no screening, biennial mammography screening for women aged from ۴۵-۷۰ is cost-effective in urban China.

Breast Neoplasms, Mammography, Mass Screening, Cost-Benefit Analysis, Urban China