Retrospective cost-effectiveness analysis of screening mammography

Area of Science:

• Health Economics
• Public Health Policy
• Breast Cancer Screening

Background:

• Mammography screening is widely recommended for women over 40, with over 70% participation.
• Societal impact of screening costs and quality-adjusted life-years (QALYs) remains understudied.
• This study retrospectively analyzes U.S. mammography screening practices from 1990-2000.

Purpose of the Study:

• To compare the cost-effectiveness of actual U.S. screening mammography patterns with alternative scenarios.
• To evaluate the societal impact on costs and QALYs.
• To inform optimal screening policy development.

Main Methods:

• A discrete-event simulation model of breast cancer epidemiology was employed.
• Estimated costs and QALYs for observed screening patterns, no screening, and 64 alternative scenarios.
• Calculated incremental cost-effectiveness ratios and performed sensitivity analyses.

Main Results:

• Actual U.S. screening cost $166 billion, gaining 1.7 million QALYs compared to no screening.
• Annual screening for all women aged 40-80 was the most expensive alternative.
• Many alternative scenarios offered more QALYs for less cost, with potential savings up to $6 billion.
• Cost-effectiveness was highly sensitive to short-term quality-of-life effects of mammography.

Conclusions:

• Efficient screening policies require balancing costs, participation incentives, and acute quality-of-life impacts.
• Current screening recommendations may not represent the most cost-effective approach.
• Further research into optimizing screening frequency and target populations is warranted.