Equity impact and cost-effectiveness of a community health worker breast cancer educational programme in rural South Africa: a modelling study

Introduction Breast cancer is a leading cause of cancer-related death among women. Women with lower income, those living in rural areas and women of Black ethnicity are more likely to be diagnosed at advanced stages and have poorer survival outcomes.

Reducing these inequities is an important public health priority. This study aimed to identify a cost-effective strategy for reducing breast cancer-related inequities and to evaluate the equity impact of the intervention across population subgroups.

Methods We developed a novel individual-level microsimulation model to assess both the equity impact and cost-effectiveness of a community health worker-led education intervention in rural areas. The model, with annual cycles, simulated rural and urban breast cancer populations in South Africa using data from national and regional cancer datasets and followed individuals over a lifetime horizon.

Costs were estimated from the provider perspective and outcomes included life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) compared with three willingness-to-pay thresholds (ZAR 58 018/ZAR 109 468/ZAR 328 408). Parameter uncertainty was explored using probabilistic sensitivity analysis.