Economic Evaluation of Breast Cancer Screening in China: A Systematic Review of Costs and Cost-Effectiveness

OBJECTIVES: This study systematically reviewed evidence on the cost and cost-effectiveness of breast cancer screening programs in China to support the development of structured, population-based screening initiatives and guide future economic evaluations. METHODS: A comprehensive search was conducted across Web of Science, CINAHL, PubMed, Embase, Medline, Google Scholar, PsycINFO, Cochrane, Scopus, and China National Knowledge Infrastructure for studies published up to June 2025. Eligible studies reported costs or cost-effectiveness of breast cancer screening in China. Data extraction followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and study quality was assessed using the Consensus Health Economic Criteria extended checklist. RESULTS: Seventeen studies met the inclusion criteria, examining mammography, ultrasound, and clinical breast examinations. The studies varied in screening strategies, cost components, and analytic methods. Eighty percent concluded that breast cancer screening was cost-effective compared with no screening, typically at thresholds between 1 and 3 times China's gross domestic product (GDP) per capita (US$13 300-39 900 per quality-adjusted life-years) in 2024. Population-based programs are generally cost-effective for women aged around 35 to 74 and have shown favorable results mainly in urban or economically developed regions. Recommendations varied by target population, screening tools, screening delivery models, intervals, and uptake. Ten articles were rated as good or excellent, 5 as moderate, and 2 as low quality. CONCLUSIONS: This review summarizes evidence to inform the development of regionally adapted, cost-effective screening policies and support evidence-based decision making in breast cancer control. It also identifies methodological inconsistencies and limited rural evaluations, emphasizing the need for more robust and context-specific economic analyses.