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However, the cost-effectiveness of national breast cancer screening programmes in China remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hybrid decision tree\u2013Markov model simulated lifetime costs and outcomes for 100\u2009000\u2009women aged 30\u201380 years from a societal perspective under rural and urban screening settings. Screening effectiveness was derived from national multicentre data and regional meta-analyses, with costs based on national surveys and multicentre treatment estimates. Parameter uncertainties were evaluated using deterministic and probabilistic sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incremental cost per quality adjusted life year (QALY) gained ranged from US$0.04 to US$0.07\u2009million for Cervical Cancer and Breast Cancer Screening Programme for Women\u2013Breast Cancer (CCBCSPW\u2013BC) and US$0.08 to US$0.13\u2009million for Cancer Screening Programme in Urban Areas\u2013Breast Cancer (CanSPUA\u2013BC) across screening frequencies. At current utilisation levels, neither programme was cost-effective at willingness-to-pay thresholds of one or three times China\u2019s per capita gross domestic product although CCBCSPW\u2013BC demonstrated better economic performance. Scenario analysis showed that if referral compliance increased to \u226570% in rural settings or \u226580% in urban settings, CCBCSPW\u2013BC screening every 3\u20135 years could meet cost-effectiveness thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Under current implementation conditions, neither programme is cost-effective. Improving referral compliance is a key barrier to enhancing screening effectiveness. Strengthening targeting strategies and optimising screening pathways will be critical to balance overdiagnosis and missed detection in future screening practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-005423","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T12:35:16Z","timestamp":1787056516000},"page":"e005423","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of two major population-based breast cancer screening programmes in China: a model-based economic evaluation"],"prefix":"10.1136","volume":"4","author":[{"given":"Ao","family":"Li","sequence":"first","affiliation":[{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China, Chengdu, Sichuan, China"},{"name":"Choosing Wisely China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyong","family":"Lu","sequence":"additional","affiliation":[{"name":"Choosing Wisely China, Chengdu, Sichuan, China"},{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1131-4158","authenticated-orcid":false,"given":"Zhongzhou","family":"Yang","sequence":"additional","affiliation":[{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China, Chengdu, Sichuan, China"},{"name":"Choosing Wisely China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China, Chengdu, Sichuan, China"},{"name":"National University Singapore Saw Swee Hock School of Public Health, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Luo","sequence":"additional","affiliation":[{"name":"Breast Center, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China"},{"name":"Sichuan Provincial Engineering Research Center of Intelligent Diagnosis and Treatment of Breast Diseases, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Jing","sequence":"additional","affiliation":[{"name":"Sichuan Provincial Engineering Research Center of Intelligent Diagnosis and Treatment of Breast Diseases, Chengdu, China"},{"name":"Institute of Breast Health Medicine, West China Hospital, Sichuan University, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9501-1535","authenticated-orcid":false,"given":"Jay","family":"Pan","sequence":"additional","affiliation":[{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China, Chengdu, Sichuan, China"},{"name":"Choosing Wisely China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2026081805351086000_4.3.e005423.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026081805351086000_4.3.e005423.2","unstructured":"World Bank . 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