Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran

  • Zehtab, Nooshin (Health Economics, Social Determinants of Health Research Center) ;
  • Jafari, Mohammad (Kerman province health insurance) ;
  • Barooni, Mohsen (Health Economics, Research center for modeling in health) ;
  • Nakhaee, Nouzar (Community Medicine, Neuroscience Research Center, Institute of Neuropharmacology) ;
  • Goudarzi, Reza (Health Economics, Health Services Management Research Center) ;
  • Zadeh, Mohammad Hassan Larry (Department of Radiotherapy and Oncology, Kerman University of Medical Sciences)
  • Published : 2016.03.07


Background: Although breast cancer is the most common cancer in women, economic evaluation of breast cancer screening is not fully addressed in developing countries. The main objective of the present study was to analyze the cost-effectiveness of breast cancer screening using mammography in 35-69 year old women in an Iranian setting. Materials and Methods: This was an economic evaluation study assessing the cost-effectiveness of a population-based screening program in 35-69 year old women residing in rural areas of South east Iran. The study was conducted from the perspective of policy-makers of insurance. The study population consisted of 35- to 69-year old women in rural areas of Kerman with a population of about 19,651 in 2013. The decision tree modeling and economic evaluation software were used for cost-effectiveness and sensitivity analyses of the interventions. Results: The total cost of the screening program was 7,067.69 US$ and the total effectiveness for screening and no-screening interventions was 0.06171 and 0.00864 disability adjusted life years averted, respectively. The average cost-effectiveness ratio DALY averted US$ for screening intervention was 7,7082.5 US$ per DALY averted and 589,027 US $ for no-screening intervention. The incremental cost-effectiveness ratio DALY averted was 6,264 US$ per DALY averted for screening intervention compared with no-screening intervention. Conclusions: Although the screening intervention is more cost-effective than the alternative (noscreening) strategy, it seems that including breast cancer screening program in health insurance package may not be recommended as long as the target group has a low participation rate.


Cost-effectiveness;screening;breast cancer;DALY averted


  1. Akbari ME, Haghighatkhah H, Shafiee M, et al (2012). Mammography and ultrasonography reports compared with tissue diagnosis - an evidence based study in Iran, 2010. Asian Pac J Cancer Prev, 13, 1907-10.
  2. Alsanabani JA, Gilan W, Al Saadi A (2015). Incidence data for breast cancer among yemeni female patients with palpable breast lumps. Asian Pac J Cancer Prev, 16, 191-4.
  3. Anderson BO, Yip CH, Smith RA, et al (2008). Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer, 113, 2221-43.
  4. Bang H, Zhao H (2012). Average cost-effectiveness ratio with censored data. Journal of Biopharmaceutical Statistics, 22, 401-15.
  5. Carles M, Vilaprinyo E, Cots F, et al (2011). Cost-effectiveness of early detection of breast cancer in Catalonia (Spain). BMC Cancer, 11, 2-11.
  6. Davari M, Makarian F, Hosseini M, et al (2013). Evaluation of direct medical costs of breast cancer in Iran; Analysis of data from patients in a hospital specialized in cancer patients. Health Information Management Journal, 10, 1-10.
  7. De Gelder R, Bulliard JL, Wolf CD, et al (2009). Cost-effectiveness of opportunistic versus organized mammography screening in Switzerland. European Journal of cancer, 45, 127-38.
  8. Eichler HG, Kong SX, Gerth WC, et al (2004). Use of costeffectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge?. Value In Health, 7, 518-28.
  9. Farshbaf Khalili A, Shahnaz M, Qahvechi A, Jafar B (1999). Attitude of women referred to Tabriz health center regarding breast self-examination. Nursing and Midwifery Journal, Tabriz, 11, 38-46.
  10. GLOBOCAN 2012 (IARC) Section of Cancer Information.
  11. Greif M (2010). Mammographic screening for breast cancer: An invited review of the benefits and costs. The Breast, 19, 268-72.
  12. Groot MT, Rob B, Groot CA, et al (2006). Costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America, and Asia. The Breast Journal, 12, 81-90.
  13. Hae KM, Park EC, Choi KS, et al (2013). The national cancer screening program for breast cancer in the Republic of Korea: is it cost-effective? Asian Pacific J Cancer Prev, 14, 2059-65.
  14. Haghighat S (2013). Cost-effectiveness of mammography screening in iranian female. shahid beheshti university of medical sciences, Tehran.
  15. Hoang Nguyen L, Laohasiriwong W, Frederick Stewart J, et al (2013). Cost-effectiveness analysis of a screening program for breast cancer in Vietnam. Value In Health Regional, 2, 21-8.
  16. Jafari M, Nakhaee N, Goudarzi R, et al (2015). Participation of the women covered by family physicians in breast cancer screening program in Iran: 2014. Asian Pac J Cancer Prev, 16, 4555-61.
  17. KI-BONG Y, Jeoung AK, Eun C, et al (2013). Is Mammography for breast cancer screening cost-effective in both western and asian countries? : results of a systematic review. Asian Pac J Cancer Prev, 14, 4141-49.
  18. Lamberts OQ, Draisma G, Der Kinderen A, L Brown M, J De Koning H (2008). Breast cancer screening policies in developing countries: a cost-effectiveness analysis for India. JNCI, 100, 1290-300.
  19. Laurens NM, Sten GZ, Gutierrez-Delgado C, et al (2014). Costeffectiveness of breast cancer control strategies in central America: The cases of Costa Rica and Mexico. PLOS ONE, 9, 95836.
  20. Mahboub-Ahari A, Pourreza A, Sari AA, et al (2014). Stated time preferences for health: a systematic review and meta analysis of private and social discount rates. J Res Health Sci, 14, 181-6.
  21. Mandelblatt J, Freeman H, Winczewski D, et al (1997). The Costs and effects of cervical and breast cancer screening in a public hospital emergency room. Am J Public Hlth, 87, 1182-89.
  22. Melnikow Joy, J.Tancredi D, Yang Z, et al (2013). Programspecific cost-effectiveness analysis: breast cancer screening policies for a safety-net program. Value Health, 16, 932-41.
  23. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. Annals of Oncology, 20, 556-63.
  24. Nahvijou A, Hadji M, BaratiMarnani A, et al (2014). A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking. Asian Pacific J Cancer Prev, 15, 8229- 37.
  25. Reza Z, Barooni M, Jafari M (2014). Assessing the costeffectiveness of breast cancer screening; a systematic review. Undergraduate. Health Care Management. 1-126.
  26. Rojnik K, Naversnik K, Mateovic-Rojnik T, PrimicZakelj M (2008). Probabilistic Cost-Effectiveness Modeling of Different Breast Cancer Screening Policies in Slovenia. Value in Health, 11, 139-48.
  27. Sari AA, Ravaghi H, Mobinizadeh M, et al (2013). The Costutility analysis of PET-scan in diagnosis and treatment of non-small cell lung carcinoma in Iran. Iranian Journal of Radiology, 10, 1-7.
  28. WHO (2008). Global Cancer Facts & Figures. 2nd Edition, 1-37.
  29. WHO (2003). Assessing the environmental burden of disease at national and local levels. Geneva, World Health Organization. WHO Environmental Burden of Disease Series, 1, 32-3.
  30. Yip CH, Smith RA, Anderson BO (2008). Guideline implementation for breast healthcare in low- and middleincome countries: early detection resource allocation. Cancer, 113, 2244-56.