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What Is the Most Cost-Effective Population-Based Cancer Screening Program for Chinese Women?

Pauline P.S. Woo, Jane J. Kim, Gabriel M. Leung

From the Department of Community Medicine and School of Public Health, University of Hong Kong, Pokfulam, Hong Kong, China; and the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA

Address reprint requests to Gabriel M. Leung, MD, Department of Community Medicine, 21 Sassoon Rd, Faculty of Medicine Bldg, University of Hong Kong, Pokfulam, Hong Kong, China; e-mail: gmleung{at}hku.hk

PURPOSE: To develop a policy-relevant generalized cost-effectiveness (CE) model of population-based cancer screening for Chinese women.

METHODS: Disability-adjusted life-years (DALYs) averted and associated screening and treatment costs under population-based screening using cervical cytology (cervical cancer), mammography (breast cancer), and fecal occult blood testing (FOBT), sigmoidoscopy, FOBT plus sigmoidoscopy, or colonoscopy (colorectal cancer) were estimated, from which average and incremental CE ratios were generated. Probabilistic sensitivity analysis was undertaken to assess stochasticity, parameter uncertainty, and model assumptions.

RESULTS: Cervical, breast, and colorectal cancers were together responsible for 13,556 DALYs (in a 1:4:3 ratio, respectively) in Hong Kong's 3.4 million female population annually. All status quo strategies were dominated, thus confirming the suboptimal efficiency of opportunistic screening. Current patterns of screening averted 471 DALYs every year, which could potentially be more than doubled to 1,161 DALYs under the same screening and treatment budgetary threshold of US $50 million with 100% Pap coverage every 4 years and 30% coverage of colonoscopy every 10 years. With higher budgetary caps, biennial mammographic screening starting at age 50 years can be introduced.

CONCLUSION: Our findings have informed how best to achieve allocative efficiency in deploying scarce cancer care dollars but must be coupled with better integrated care planning, improved intersectoral coordination, increased resources, and stronger political will to realize the potential health and economic gains as demonstrated.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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