OBJECTIVES: Breast cancer is the most common cancer among Chinese women. This study aims to estimate the cost-effectiveness of nine strategies for detecting breast cancer at early stage in China setting, from a societal perspective.

METHODS: A Markov model was constructed to predict breast cancer incidence and mortality in three cohorts of 100,000 Chinese women separately aged from 35, 40 and 45 and followed until 70, with or without an annual/biennial screening. Three common screening technologies-clinical breast examination (CBE), mammography (MAM) and ultrasonography (US)-were separately used or combined together in different ways. The total costs including screening and treatment of breast cancer were also estimated for each screening strategy. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses.

RESULTS: With incremental cost-effectiveness ratio (ICER) of Chinese Yuan (CNY) per quality-adjusted life-year (QALY) averted, annual screening by CBE alone, MAM alone and using US alone at the first stage followed by MAM when indicated dominated other options. Average cost per QALY averted increased when enhancing the starting age of screening or shortening screening interval. However, with the threshold of triple GDP per capita of China in 2017 (CNY 1,739,590, approximately USD 25,749), no screening strategy was acceptable because they are too costly to gain one QALY.

CONCLUSIONS: The present results suggested that regular screening of breast cancer currently may not be cost effective for Chinese women. Without any mass screening programme, national cancer registry data has recently shown a decrease trend in breast cancer mortality in China, mainly because of the implementation of standardised treatment However, the cost-effectiveness analysis of screening strategy specified for high-risk group is still needed in future research to assess if it is a good way to improve outcome further.