Abstract
BACKGROUND: Breast cancer remains the most diagnosed cancer in European countries, with diverse screening modalities requiring economic evaluation for optimal resource allocation. This systematic review evaluated the cost-effectiveness of breast cancer screening strategies across European healthcare contexts. METHODS: We conducted a comprehensive search across PubMed, ScienceDirect, Cochrane Library, Scopus, and Google Scholar following PRISMA guidelines (1990-2024). Studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Economic standardization employed healthcare-specific inflation indices and purchasing power parity adjustments, with costs converted to 2020 EUR. RESULTS: From 1449 studies, 23 met inclusion criteria, with significant geographic imbalance (74% from North-Western/Central Europe, 4% from South-Eastern Europe). Mammography screening for women aged 50-69 years demonstrated consistent cost-effectiveness (EUR 3000-8000 per quality-adjusted life year (QALY)) with high confidence. For women under 50, screening showed substantially higher costs (EUR 105,000 per year of life saved). Magnetic resonance imaging (MRI) screening showed cost-effectiveness for high-risk populations (EUR 18,201-33,534 per QALY) with moderate confidence. CONCLUSIONS: Biennial mammography screening for women aged 50-69 demonstrates consistent cost-effectiveness across European contexts. Findings have highest applicability to North-Western and Central European healthcare systems, with limited generalizability to Southern and Eastern Europe due to evidence gaps.