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1 December 1997 | Volume 127 Issue 11 | Pages 955-965
Background: Screening mammography is recommended for women 50 to 69 years of age because of its proven efficacy and reasonable cost-effectiveness. Extending screening recommendations to include women 40 to 49 years of age remains controversial.
Objective: To compare the cost-effectiveness of screening mammography in women of different age groups.
Design: Cost-effectiveness analysis done using Markov and Monte Carlo models.
Patients: General population of women 40 years of age and older.
Interventions: Biennial screening from 50 to 69 years of age was compared with no screening. Screening done every 18 months from ages 40 to 49 years, followed by biennial screening from ages 50 to 69 years, was compared with biennial screening from ages 50 to 69 years.
Measurements: Life-expectancy, costs, and incremental cost-effectiveness.
Results: Screening women from 50 to 69 years of age improved life expectancy by 12 days at a cost of $704 per woman, resulting in a cost-effectiveness ratio of $21 400 per year of life saved. Extending screening to include women 40 to 49 years of age improved life expectancy by 2.5 days at a cost of $676 per woman. The incremental cost-effectiveness of screening women 40 to 49 years of age was $105 000 per year of life saved. On the basis of a multiway sensitivity analysis, there is a 75% chance that screening mammography in women 50 to 69 years of age costs less than $50 000 per year of life saved, compared with a 7% chance in women 40 to 49 years of age.
Conclusion: The cost-effectiveness of screening mammography in women 40 to 49 years of age is almost five times that in older women. When breast cancer screening policies are being set, the incremental cost-effectiveness of extending mammographic screening to younger women should be considered.
Author and Article Information
From the Department of Veterans Affairs and University of California, San Francisco, San Francisco, California.
ARTICLE
Cost-Effectiveness of Extending Screening Mammography Guidelines To Include Women 40 to 49 Years of Age
Acknowledgments: The authors thank Martin Brown, PhD, for technical assistance and critical review of the manuscript.
Grant Support: By a National Cancer Institute-funded Breast Cancer SPORE (Specialized Programs of Research Excellence) grant P50 CA58207 and by National Cancer Institute-funded Breast Cancer Surveillance Consortium cooperative agreement 1 U01 CA 63740.
Requests for Reprints: Karla Kerlikowske, MD, San Francisco Veterans Affairs Medical Center, General Internal Medicine Section. 111A1, 4150 Clement Street, San Francisco, CA 94121.
Current Author Addresses: Drs. Salzmann and Kerlikowske: San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement Street, San Francisco, CA 94121.
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