Optimization Of Breast Cancer Screening Strategies For Rural Women In China Based On Cost-Effectiveness Evaluation

[Purpose] This study explores breast cancer screening strategies by screening start and stop ages,screening intervals,screening methods,and cost-effectiveness analysis to optimize breast cancer screening strategies in China and improve our breast cancer screening system.From the perspective of cost-effectiveness to find the most suitable screening strategy for rural women in China.Simultaneously,And using the research data in Hubei Province,analyzing the short-term effects and long-term effects of the two screening strategies were,which provided a scientific basis for decision-making institutions to develop breast cancer screening strategies for the appropriate population in Hubei Province.[Methods] The study was obtained basic data and key parameters through literature studies,field surveys,key informant interviews,and Getdata Graph Digitizer methods.Using the Markov model to analyze the cost-effectiveness of screening,Treeage Pro2018 software was used to construct the Markov screening model for breast cancer screening,and 132 screening strategies were constructed and cost-effectiveness analysis was performed.Calculate the incremental cost,incremental effect,and incremental cost-effectiveness ratio.[Results] According to the results of model simulation,there are 7 advantages optional strategies,which are(1)CBE-BUS once every 2 years for 40-59 years old,(2)CBE-BUS once every 3 years for 30-64 years old,(3)CBE once every three years for30-64 years old,(4)CBE+MAM once every 2 years for 30-64 years old,(5)CBE-MAM every 2 years for 30-64 years old,(6)CBE+BUS once every 2 years for30-64 years old,(7)30-64 years old BUS+MAM every 2 years,the most suitable alternative strategy for rural women in China is CBE-MAM,which is 30-64 years every 3 years,the cost is 2,477.31 yuan,and the average cost of saving 25.01 QALY is98.78 yuan.A total of 600 breast cancer patients and 350 women were surveyed in Hubei Province,and a cost-effectiveness analysis was conducted on the screeningstrategies currently being implemented in two regions of Hubei Province(CBE+BUS-MAM and BUS-MAM).BUS-MAM is the most cost-effective screening strategy.Compared with no screening,the cost per LY saved is 17837.88 yuan,and the cost per additional QALY is 23176.84 yuan.The sensitivity analysis found that the health utility value and treatment cost had the greatest impact on the model.The screening cost,screening organization cost and sensitivity had little effect on the model,and the screening method specificity had no effect on the model.Compared with the unscreened group,the effect of the incremental cost effect on the model is the poverty rate,the health utility value of the stage I breast cancer,the screening cost,and the treatment cost has little effect on the model.[Conclusions] The results of the study showed that CBE-MAM,which is once every 2years from 30-64 years old,is the most suitable breast cancer screening strategy for China’s national conditions and female physiological characteristics.Therefore,this study suggests that the screening start age should be 5 years old and the screening interval adjusted to 2 years.The screening method should consider the clinical breast examination and supplement the mammography.Breast ultrasound examination is not recommended.Although the alternative strategy for the Hubei Breast Cancer Screening Project is BUS-MAM,CBE-MAM screening is still recommended to achieve optimal strategies.