Total cost-effectiveness of mammography screening strategies

Background: Breast cancer screening technology and treatment have improved over the past decade. This analysis evaluates the total cost-effectiveness of various breast cancer screening strategies in Canada. Data and methods: Using the Wisconsin Cancer Intervention and Surveillance Monitoring Network (CISNET) breast cancer simulation model adapted to the Canadian context, costs and quality-adjusted life years (QALY) were evaluated for 11 mammography screening strategies that varied by start/stop age and screening frequency for the general population. Incremental cost-effectiveness ratios are presented, and sensitivity analyses are used to assess the robustness of model conclusions. Results: Incremental cost-effectiveness analysis showed that triennial screening at ages 50 to 69 was the most cost-effective at $94,762 per QALY. Biennial ($97,006 per QALY) and annual ($226,278 per QALY) strategies had higher incremental ratios. Interpretation: The benefits and costs of screening rise with the number of screens per woman. Decisions about screening strategies may be influenced by willingness to pay and the rate of recall for further examination after positive screens.