THE COST-EFFECTIVENESS OF MAMMOGRAPHIC SCREENING STRATEGIES

Objective.-To compare and analyze the cost-effectiveness of different mammographic screening strategies. Design.-A computer simulation model was developed to compare mammographic screening with observation without screening. Cost-effectiveness was expressed as marginal cost per year of life saved (MCYLS) and was calculated for the following mammographic screening strategies: (1) annual for ages 40 to 79 years; (2) annual for ages 50 to 79 years; (3) biennial for ages 50 to 79 years; (4) annual for ages 40 to 49 years with biennial for ages 50 to 79 years; (5) annual for ages 40 to 64 years with biennial for ages 65 to 79 years; (6) biennial for ages 40 to 49 years with annual for ages 50 to 79 years; and (7) annual for high-risk and biennial for normal-risk women aged 40 to 49 years with annual for ages 50 to 79 years. Data Sources.-The probability and cost of all outcomes were established from previously published data or community experience. Results.-The most cost-effective screening strategy is biennial mammography for women aged 50 to 79 years, with an MCYLS of $16 000. Adding annual mammography for women aged 40 to 49 years increases the MCYLS to $20 200, but is more cost-effective than other tested protocols that included women in their 40s; annual mammography for ages 40 to 49 years with biennial for ages 50 to 79 years is also more cost-effective than annual mammography for ages 50 to 79 years. Conclusion.-Screening programs that include women in their 40s can be as cost-effective as some that exclude such women. Choice of a screening strategy depends on financial resources and desired effectiveness.