Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries:A systematic review

Background Low-and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strat-egies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs. Methods A systematic article search was conducted through Med -line, Embase, Web of Science, and Econlit. Studies were includ-ed only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narrative-ly. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extend-ed checklist. Results This review identified 21 studies economically evaluat-ing mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determin-ing cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combi-nation with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients). Conclusions Mammography screening appeared to be a cost-ef-fective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammogra-phy screening in these regions.