Cost-effectiveness of extending screening mammography guidelines to include women 40 to 49 years of age

Department of Veterans Affairs, San Francisco, California, USA.
Annals of internal medicine (Impact Factor: 16.1). 01/1998; 127(11):955-65.
Source: PubMed

ABSTRACT Screening mammography is recommended for women 50 to 69 years of age because of its proven efficacy and reasonable cost-effectiveness. Extending screening recommendations to include women 40 to 49 years of age remains controversial.
To compare the cost-effectiveness of screening mammography in women of different age groups.
Cost-effectiveness analysis done using Markov and Monte Carlo models.
General population of women 40 years of age and older.
Biennial screening from 50 to 69 years of age was compared with no screening. Screening done every 18 months from ages 40 to 49 years, followed by biennial screening from ages 50 to 69 years, was compared with biennial screening from ages 50 to 69 years.
Life-expectancy, costs, and incremental cost-effectiveness.
Screening women from 50 to 69 years of age improved life expectancy by 12 days at a cost of $704 per woman, resulting in a cost-effectiveness ratio of $21,400 per year of life saved. Extending screening to include women 40 to 49 years of age improved life expectancy by 2.5 days at a cost of $676 per woman. The incremental cost-effectiveness of screening women 40 to 49 years of age was $105,000 per year of life saved. On the basis of a multiway sensitivity analysis, there is a 75% chance that screening mammography in women 50 to 69 years of age costs less than $50,000 per year of life saved, compared with a 7% chance in women 40 to 49 years of age.
The cost-effectiveness of screening mammography in women 40 to 49 years of age is almost five times that in older women. When breast cancer screening policies are being set, the incremental cost-effectiveness of extending mammographic screening to younger women should be considered.

  • Source
    • "To date there is little research evaluating the cost-effectiveness of breast cancer screening programs combining MM and CBE while incorporating costs other than screening examinations, including costs of diagnostic follow-up due to abnormal examinations, treatment, and post-treatment costs after diagnosis. While some studies have included treatment costs subsequent to diagnosis[9] [10] [11] [3] [8] [13] [20], they have often been limited to specific age cohorts or subgroups (e.g. women older than 65). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Breast cancer screening by mammography and clinical breast exam are commonly used for early tumor detection. Previous cost-effectiveness studies considered mammography alone or did not account for all relevant costs. In this study, we assessed the cost-effectiveness of screening schedules recommended by three major cancer organizations and compared them with alternative strategies. We considered costs of screening examinations, subsequent work-up, biopsy, and treatment interventions after diagnosis. We used a microsimulation model to generate women's life histories, and assessed screening and treatment effects on survival. Using statistical models, we accounted for age-specific incidence, preclinical disease duration, and age-specific sensitivity and specificity for each screening modality. The outcomes of interest were quality-adjusted life years (QALY) saved and total costs with a 3% annual discount rate. Incremental cost-effectiveness ratios were used to compare strategies. Sensitivity analyses were done by varying some of the assumptions. Compared with guidelines from the National Cancer Institute and the U.S. Preventive Services Task Force, alternative strategies were more efficient. Mammography and clinical breast exam in alternating years from ages 40 to 79 years was a cost-effective alternative compared with the guidelines, costing $35,500 per QALY saved compared with no screening. The American Cancer Society guideline was the most effective and the most expensive, costing over $680,000 for an added QALY compared with the above alternative. Screening strategies with lower costs and benefits comparable with those currently recommended should be considered for implementation in practice and for future guidelines.
    Cancer Epidemiology Biomarkers & Prevention 04/2009; 18(3):718-25. DOI:10.1158/1055-9965.EPI-08-0918 · 4.32 Impact Factor
  • Source
    • "Screening for breast cancer with biennial mammography for women aged 50–70 years has proven costeffective in many countries in Europe and in the USA. The ICER compared to surveillance alone is highly variable across nations with decision-tree analyses giving estimates from approximately £1100/life-year gained in the UK to $21 400/life-year in the USA [3] [4] . In contrast to mammography, the ability of the higher cost techniques of CT, MRI and PET to be cost-effective in cancer screening remains to be demonstrated. "
    [Show abstract] [Hide abstract]
    ABSTRACT: With expenditure on imaging patients with cancer set to increase in line with rising cancer prevalence, there is a need to demonstrate the cost-effectiveness of advanced cancer imaging techniques. Cost-effectiveness studies aim to quantify the cost of providing a service relative to the amount of desirable outcome gained, such as improvements in patient survival. Yet, the impact of imaging on the survival of patients with cancer is small compared to the impact of treatment and is therefore hard to measure directly. Hence, techniques such as decision-tree analysis, that model the impact of imaging on survival, are increasingly used for cost-effectiveness evaluations. Using such techniques, imaging strategies that utilise computed tomography, magnetic resonance imaging and positron emission tomography have been shown to be more cost-effective than non-imaging approaches for the management of certain cancers including lung, prostate and lymphoma. There is stronger evidence to support the cost-effectiveness of advanced cancer imaging for diagnosis, staging and monitoring therapy than for screening. The results of cost-effectiveness evaluations are not directly transferable between countries or tumour types and hence more studies are needed. As many of the techniques developed to assess the evidence base for therapeutic modalities are not readily applicable to diagnostic tests, cancer imaging specialists need to define the methods for health technology assessment that are most appropriate to their speciality.
    Cancer Imaging 02/2004; 4(2):97-103. DOI:10.1102/1470-7330.2004.0017 · 1.29 Impact Factor
  • Source
    • "As an example , consider the debate over whether to provide yearly mammograms to women under fifty . According to one synthesis of the literature , yearly mammogram screening is not as cost - effective for women under fifty as it is for women between fifty and sixty - nine ( $ 105 , 000 per cost of year gained for the former relative to less than $ 50 , 000 for the latter ) ( Salzmann , Karlikowske , and Phillips 1997 ; see also Eddy 1997 ; Hirth et al . 2000 ) . "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article provides an initial look at how managed care organizations (MCOs) might incorporate cost-effectiveness analysis (CEA) into their decision-making process and how the courts might respond. Because so few medical liability cases directly involve CEA, we must look at other areas of the law to assess potential MCO liability for applying CEA. In general negligence cases, courts rely on a risk-benefit test to determine customary practice. Likewise, in product liability cases, courts use a risk-utility calculus to determine liability for product design defects. And in challenges to government regulation, courts examine how agencies use CEA to set regulatory policy. The results have been mixed. In product liability cases, CEA has led to some punitive damage awards against automobile manufacturers. But courts have integrated it in negligence cases without generating juror antipathy, and generally defer to agency expertise in how to incorporate CEA. The article discusses the implications of these cases for MCO use of CEA and outlines various options for setting the standard of care in the managed care era.
    Journal of Health Politics Policy and Law 05/2001; 26(2):291-326. DOI:10.1215/03616878-26-2-291 · 0.96 Impact Factor
Show more