Counting the costs of mammography screening: first year results from the Sydney study

Population-based mammography screening is a highly specialized service which aims to improve the early detection of breast cancer. This is achieved through the installation of a dedicated mix of medical technology and professional skills. It is therefore a resource-intensive activity so the benefits foregone by deploying these resources for mammography screening ought to be determined to investigate the relative efficiency of such a commitment. This paper describes the costing methodology used in the evaluation of the Sydney Breast X-ray Programme and presents the health service costs for the first 12 months of operation. In the first year when attendance was under 5000 it cost $118.93 to screen a woman, $13,817 to detect a cancer and $18,720 to detect an impalpable cancer. However, costs are expected to fall in subsequent years as attendance reaches capacity level. The first screening round will detect prevalent cancers; costs will change with subsequent screening rounds as incident cancers are detected. We are cautious in extrapolating the costs of a national programme from these results. However, on the basis of our data and disregarding treatment costs, a national programme which screened 70% of all Australian women over the age of 45 years every two years would add between $60 million and $100 million to the national health bill each year.