摘要Objective:To evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions,and explore mediating pathways across diagnosis,initial treatment,radiotherapy/chemotherapy,follow-up,and recurrence/progression/metastasis.Methods:A multicentre,nationwide survey across 5 disease courses was conducted from 26 hospitals in China.Multivariable regression and structural equation modeling were used to assess the effects of government-organized screening on economic burden by comparing government-organized screening with workplace check-up,self-paid check-up,and symptom-based detection.Results:Workplace check-up,self-paid check-up,and symptom-based detection were associated with progressively higher costs across diagnosis[β:1.10,95%confidence interval(CI):0.54-1.67;β:1.46,95%CI:1.00-1.92;and β:1.68,95%CI:1.25-2.11,respectively],initial treatment(β:0.36,95%CI:0.18-0.55;β:0.51,95%CI:0.35-0.66;and β:0.56,95%CI:0.42-0.70,respectively),and follow-up(β:0.63,95%CI:0.38-0.88;β:0.83,95%CI:0.61-1.04;and β:0.85,95%CI:0.65-1.06,respectively)compared to government-organized screening(all P<0.05).Earlier clinical staging and greater use of lower-level hospitals mediated 44.74%-54.97%of cost differences in diagnosis,73.27%-85.04%in initial treatment,and 30.38%-54.73%in follow-up.Fifteen percent of the cost differences during initial treatment were related to lower overtreatment for precancerous lesions.Conclusions:Government-led cervical cancer screening was associated with lower economic burden with pathways involving earlier-stage diagnosis,reduced overtreatment,and decreased reliance on higher-level hospitals,suggesting potential clinical benefits,efficient resource use,and improved equity in cancer care.