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BACKGROUND: In Ethiopia, breast cancer is the most commonly diagnosed cancer among women, with most cases identified at advanced stages. Clinical breast examination (CBE) presents a potentially viable and affordable screening option in low-resource settings; however, its cost effectiveness has not been evaluated within the Ethiopian context.AIM: The aim of this study was to evaluate the cost-effectiveness of one-time CBE screening for breast cancer of women 30 years and older in Ethiopia.

METHODS: A state-transition Markov model was developed to simulate the natural history, detection, and post-diagnosis progression of breast cancer in a hypothetical cohort of 10,000 women aged 30 and above, all assumed to have undiagnosed, screen-detectable disease. The model was run over a lifetime horizon and operated in annual cycles. It included health states representing the full spectrum of breast cancer progression, from Ductal Carcinoma in Situ (DCIS) through Stage 4—as well as treatment, remission, recurrence, and death. Health outcomes were measured in quality-adjusted life years (QALYs) and life years gained (LYG), with costs assessed from the healthcare payer perspective. The simulation was conducted using Microsoft Excel, and one-way sensitivity analyses were performed to assess the impact of uncertainty in input parameters.

RESULTS: In the base-case analysis, a single CBE screening led to 10.5 QALYs and 14.3 LYG per case at a cost of USD 4,467.4, compared to 10.0 QALYs and 13.7 LYG at USD 2,751.9 without screening. This produced an incremental cost-effectiveness ratio (ICER) of USD 3,462.7 per QALY gained and 2655.2 per LYG, which falls below the WHO-recommended limit of three times Ethiopia’s GDP per capita (USD 3,816). The ICER showed the greatest sensitivity to the screening cost, remission utility, test sensitivity and stage distribution.

CONCLUSION: This study suggests that implementing a one-time CBE screening for women aged 30 and above in Ethiopia is a cost-effective strategy. It has the potential to enable earlier diagnosis, improve survival outcomes, and reduce the overall burden of breast cancer. However, findings from the one-way sensitivity analysis indicate that the cost-effectiveness conclusion is sensitive to changes in key parameters, highlighting some uncertainty around the results. Despite this, the analysis supports the consideration of CBE screening as part of national cancer control strategies, particularly in low-resource settings.