Martin J. Yaffe PhD, Presenter: Research collaboration, General Electric Company Founder, Matakina International Ltd Shareholder, Matakina International Ltd Co-founder, Mammographic Physics Inc

Nicole Mittmann PhD, Abstract Co-Author: Nothing to Disclose

Natasha K. Stout PhD, Abstract Co-Author: Nothing to Disclose

Anna N. Tosteson, Abstract Co-Author: Nothing to Disclose

Amy Trentham-Dietz, Abstract Co-Author: Nothing to Disclose

Oguzhan Alagoz PhD, Abstract Co-Author: Consultant, Renaissance Rx

To examine the effect of screening regimen (age to begin and discontinue screening and interval between screens) on cost effectiveness and cost utility of screening in the context of modern imaging technology and therapies within an organized screening program as delivered in Canada

We modified the validated University of Wisconsin CISNET Breast Cancer Simulation Model to estimate breast cancer incidence and mortality on an unscreened Canadian population. After calibrating the model using empirical data on the sensitivity and specificity of mammography, we calculated cancer incidence versus age and "stage" for several screening scenarios and created a distribution of receptor positivity for hormone receptors and HER2. Outcomes for therapy, administered according to current practice guidelines, were predicted based on published data. For each scenario we calculated the number of breast cancers, deaths and years of life lost due to premature death. We factored the quality of life into our analysis by weighting with utilities and disutilities associated with various health states related to breast cancer, to express results in quality-adjusted life-years (QALY). We considered both the costs of screening and treatment to the health care system and the additional costs to society such as loss of productivity. Finally, we performed a sensitivity analysis with respect to parameters associated with screening and costs of screening and therapy.  

Compared to No Screening, routine screening provided mortality reductions of 20-50%. Evaluating outcomes in terms of life-years gained rather than lives saved shifted the benefit toward younger ages to begin screening. In general the more screens a woman had between ages 40 and 74, the greater the reduction in mortality and the more LYG and QALYs gained, but the greater the cost to the health care system, the number of abnormal recalls, negative biopsies and presumably the amount of overtreatment.

Screening reduces breast cancer mortality and is cost effective by modern standards ($70K-$100K/QALY). The cost of screening examinations is the largest single cost factor in a breast cancer care program, but the average total lifetime cost per woman for screening and care of $4000 is reasonable compared to other health interventions.

The model provides guidance for optimizing effectiveness and use of resources in a screening program.

Yaffe, M, Mittmann, N, Stout, N, Tosteson, A, Trentham-Dietz, A, Alagoz, O, Cost-Effectiveness of Screening Mammography in an Organized Program- A Modelling Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007257.html