{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:14Z","timestamp":1786973054621,"version":"build-2736575974"},"reference-count":58,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"name":"Research for Health in Conflict in the Middle East and North Africa","award":["(ES\/P010962\/1)"],"award-info":[{"award-number":["(ES\/P010962\/1)"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,1]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the cost-effectiveness of expanding the current opportunistic screening strategy to an organised and feasible population-based breast cancer screening strategy from the healthcare system perspective in Jordan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A probabilistic, state-transition cohort decision-analytic model was developed to estimate the expected incremental life years (LYs), quality-adjusted life years (QALYs) and costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The model includes a hypothetical cohort of average-risk asymptomatic Jordanian women aged 40 years and above.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The base case comparison was between organised mammography with a 50% attendance rate and opportunistic mammography for asymptomatic women aged 40\u201370 years and older over a lifetime horizon. Multiple organised mammogram screening strategies were assessed that varied in screening interval and start and end age (strategy 1: 40\u201360\u2009biennial, strategy 2: 50\u201365\u2009annual, strategy 3: 50\u201365 biennial, strategy 4: 40\u201370 biennial, strategy 5: 50\u201370 biennial and strategy 6: 40\u201349 annual).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This model-based economic evaluation study was conducted to reflect the context of the Jordanian healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurement<\/jats:title>\n                    <jats:p>We identified, measured and valued resources and outcomes to populate the model. Transition probabilities were estimated from the literature, the cancer registry or through calibration. The screening test\u2019s specificity and sensitivity were obtained from the literature. Costs and utility weights were extracted from national databases and literature. Both costs and outcomes were discounted using an annual discount rate of 3%. The model\u2019s uncertainty was tested using deterministic and probabilistic sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a lifetime horizon, strategy 3 (50\u201365\u2009biennial, 50% attendance rate) resulted in a mean discounted LYs of 22.077, a mean discounted QALYs of 16.993 and a mean discounted cost of US$994 compared with opportunistic screening, which resulted in a mean discounted LYs of 22.062, a mean discounted QALYs of 16.980 and a mean discounted cost of US$889. The incremental cost-utility ratio (ICUR) relative to opportunistic screening is US$6734 per QALY. Strategy 3 ranks first as the most cost-effective organised screening strategy for the Jordanian healthcare system, followed by strategy 4 with an ICUR of US$18\u2009024 per QALY and strategy 6 with an ICUR of US$62\u2009418 per QALY. The three strategies were presented on the cost-effectiveness frontier. The deterministic sensitivity analysis showed that the results were sensitive to the cost of the screening package and the annual discount rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At a willingness-to-pay cost-effectiveness threshold of US$42000\u201356000 per QALY, strategy 3 (50\u201365\u2009biennial, 50% attendance rate) and strategy 4 (40\u201370\u2009biennial, 50% attendance rate) are likely to be cost-effective in Jordan. However, prior to implementation, the affordability of each strategy and the availability of required infrastructure must be carefully evaluated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108486","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:25:12Z","timestamp":1786969512000},"page":"e108486","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of organised versus opportunistic mammography breast cancer screening in low-resourced country"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2952-9103","authenticated-orcid":false,"given":"Abeer","family":"Al Rabayah","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Center for Drug Policy and Technology Assessment, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olena","family":"Mandrik","sequence":"additional","affiliation":[{"name":"Sheffield Centre for Health and Related Research, Population Health, The University of Sheffield School of Medicine and Population Health, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asem","family":"Mansour","sequence":"additional","affiliation":[{"name":"King Hussein Cancer Center, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"Al-Ajlouni","sequence":"additional","affiliation":[{"name":"Jordan Breast Cancer Program, King Hussein Cancer Foundation, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1081-5824","authenticated-orcid":false,"given":"Tala","family":"Haddad","sequence":"additional","affiliation":[{"name":"King Hussein Cancer Center, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikmat","family":"Abdel-Razeq","sequence":"additional","affiliation":[{"name":"King Hussein Cancer Center, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Shamieh","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalipso","family":"Chalkidou","sequence":"additional","affiliation":[{"name":"Department of Performance, Financing and Delivery, WHO, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sullivan","sequence":"additional","affiliation":[{"name":"King\u2019s College, Institute of Cancer Policy, Centre for Conflict & Health Research, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"2026081705250782000_16.8.e108486.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2022.08.010"},{"key":"2026081705250782000_16.8.e108486.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026081705250782000_16.8.e108486.3","unstructured":"Ministry of Health . 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