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Cost-Effectiveness of Extending Screening Mammography Guidelines To Include Women 40 to 49 Years of Age

Peter Salzmann, MD; Karla Kerlikowske, MD; and Kathryn Phillips, PhD
[+] Article and Author Information

From the Department of Veterans Affairs and University of California, San Francisco, San Francisco, California. 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.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(11):955-965. doi:10.7326/0003-4819-127-11-199712010-00001
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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.

Figures

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Figure 1.
Cumulative breast cancer mortality in screened (black circles) compared with nonscreened (white circles) women.Left.Right.

Women 40 to 49 years of age. Women 50 to 69 years of age. Adapted from Kerlikowske K. Efficacy of screening mammography among women aged 40 to 49 years and 50 to 69 years: comparison of relative and absolute benefit. Monogr Natl Cancer Inst. 1997; 22:79-86, with permission.

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Figure 2.
Results of one-way sensitivity analysis.Table 1Table 2

Eleven variables that may affect the cost-effectiveness of screening 40- to 49-year-old women were systematically varied throughout the ranges listed in and .

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