title: Cost effectiveness of mammography screening for Chinese women.
abstract: BACKGROUND
  Although the cost effectiveness of screening mammography in most western developed populations has been accepted, it may not apply to Chinese women, who have a much lower breast cancer incidence. The authors estimated the cost effectiveness of biennial mammography in Hong Kong Chinese women to inform evidence-based screening policies.
  
  
  METHODS
  For the current study, a state-transition Markov model was developed to simulate mammography screening, breast cancer diagnosis, and treatment in a hypothetical cohort of Chinese women. The benefit of mammography was modeled by assuming a stage shift, in which cancers in screened women were more likely to be diagnosed at an earlier disease stage. The authors compared costs, quality-adjusted life years (QALYs) saved, and life years saved (LYS) for 5 screening strategies.
  
  
  RESULTS
  Biennial screening resulted in a gain in life expectancy ranging from 4.3 days to 9.4 days compared with no screening at an incremental cost of from US $1,166 to US $2,425 per woman. The least costly, nondominated screening option was screening from ages 40 years to 69 years, with an incremental cost-effectiveness ratio (ICER) of US $61,600 per QALY saved or US $64,400 per LYS compared with no screening. In probabilistic sensitivity analyses, the probability of the ICER being below a threshold of US $50,000 per QALY (LYS) was 15.3% (14.6%).
  
  
  CONCLUSIONS
  The current results suggested that mammography for Hong Kong Chinese women currently may not be cost effective based on the arbitrary threshold of US $50,000 per QALY. However, clinicians must remain vigilant and periodically should revisit the question of population screening: Disease rates in China have been increasing because of westernization and socioeconomic development.
authors.affiliation: Department of Community Medicine and School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Irene O L
authors.initials: IO
authors.lastname: Wong
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cowling
authors.forename: Cindy L K
authors.initials: CL
authors.lastname: Lam
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology; D003362:Cost-Benefit Analysis; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000191:economics*; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D008962:Models, Theoretical