Cost-effectiveness of mammography-based breast cancer screening in Jordan: a healthcare system perspective

Breast cancer is the most common cancer among women in Jordan, with many cases detected at advanced stages, leading to higher costs and poorer outcomes. Despite mammography's proven benefits for early detection, its use remains low. This study evaluates the cost-effectiveness and budget impact of implementing mammography screening in Jordan's healthcare system.

A cost-effectiveness analysis was conducted from the perspective of the Jordanian healthcare system, comparing mammography-based screening with no screening (opportunistic detection) among women ≥ 40 years. A Markov model estimated disease progression, costs, and quality-adjusted life years (QALYs), using primarily local/regional data, supplemented by international sources when necessary. Results were expressed as incremental cost-effectiveness ratios (ICERs), i.e., cost per QALY gained. Sensitivity analyses tested model robustness. A budget impact analysis (BIA) assessed the financial implications of implementing nationwide screening.

Comparing mammography-based screening with no screening among women ≥ 40 years, ICER was estimated at $5341 per QALY gained, which is well below Jordan's willingness-to-pay threshold. Over a lifetime horizon, mammography screening among eligible women aged 40-50 years was projected to prevent 779 breast cancer deaths. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the base-case results under uncertainty. Over five years, nationwide screening yielded net savings of $17.6 million compared to current screening estimates.

Mammography-based breast cancer screening appears to be a cost-effective strategy in Jordan, with potential to reduce breast cancer mortality. These findings suggest possible improvements in population health outcomes and more efficient use of healthcare resources.