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Mammography screening costs varied by $8 billion per strategy
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Estimated costs for mammography screening varied by $8 billion across guideline models, according to study results.
The estimated cost of actual mammography screening practices in the United States in 2010 was $7.8 billion, which was $4.4 billion more expensive than predicted costs associated with adherence to the US Preventative Services Task Force (USPSTF) biennial guidelines and $2.3 billion less expensive than the American Cancer Society annual screening guidelines.
Study researcher Cristina O’Donoghue, MD, MPH, of the University of California School of Medicine in San Francisco, and colleagues used the Behavioral Risk Factor Surveillance System 2010 survey to evaluate screening practices of women aged 40 to 85 years. They excluded women diagnosed with breast cancer within the previous 5 years to isolate screening mammography from surveillance and diagnostic mammography.
They estimated a $7.8 billion aggregate cost for mammography screening in 2010, with approximately 70% of women screened.
Researchers then compared these data with three screening strategy guidelines and 85% targeted participation rates.
They calculated biennial screening of women aged 50 to 70 years — based on European practices — would cost $2.6 billion per year, or $5.4 billion less than the actual practice costs.
ACS guidelines calling for annual screening of women aged 40 to 84 years would cost $10.1 billion per year, which would represent a $2.3 billion increase in actual costs.
USPSTF guidelines — which recommend biennial screening for women aged 50 to 74 years, as well as for high-risk women aged 40 to 49 years and 75 to 85 years — would cost $3.5 billion per year, or $4.4 billion less than actual practice costs. Researchers also found this strategy would screen 15% more women than the current practice.
Biennial and annual screening strategies had a cost difference of more than $7 billion. Also, annual screening was associated with increased risk for false-positive recalls (61.3% vs. 41.6%) and biopsy results (7% vs. 4.8%) over 10 years.
“Following mammography screening guidelines, such as those from the USPSTF, that optimize frequency on the basis of best available evidence will put us in a position to improve screening and save billions of dollars that can be invested in personalized risk-based screening and prevention strategies,” O’Donoghue and colleagues wrote. “Such a change in screening practice is likely to improve the quality of screening and is in line with our national goals of advancing health care delivery while improving cost-efficiency.”
Joann G. Elmore
The issue of cost is an important factor for patients and clinicians to consider when discussing breast cancer screening, Joann G. Elmore, MD, MPH, of the University of Washington School of Medicine and School of Public Health, and Cary P. Gross, MD, of the Cancer Outcomes Public Policy and Effectiveness Research Center at the Yale School of Medicine, wrote in an accompanying editorial.
“Costs, including out-of-pocket costs, should be part of the conversation because women with high-deductible health plans may find themselves facing a hefty bill for adjunctive imaging tests and procedures,” Elmore and Gross wrote. “At the societal level, costs should be integrated into our national dialogue about screening. It is unsustainable to remain ignorant of the costs associated with any health intervention, even breast cancer screening.”
For more information:
- Elmore JG. Ann Intern Med. 2014;160:203-204.
- O’Donoghue C. Ann Intern Med. 2014;160:145-153.
Disclosure: Gross reports a research grant from Medtronic Inc. The researchers report no relevant financial disclosures.
Perspective
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Wajeeha Razaq, MD
Since its introduction as a screening tool in the 1980s, screening mammogram has been widely prescribed in United States. Mammogram guidelines have gradually broadened and now recommend screening for all women older than age 40 annually (American Cancer Society) or biennially (US Preventive Services Task Force).
Early detection remains the primary defense available to patients for preventing the development of life-threatening breast cancer, although advances in imaging technology and disagreements over recommended schedules have complicated the issue of screening.
The recent article by O’Donoghue and colleagues in Annals of Internal Medicine is an excellent overview of cost analysis of breast cancer screening in the United States, a topic that is never discussed during any clinical trials nor when implementing guidelines. Previous cost-effectiveness studies have concluded that, in general, screening mammography would be cost-effective compared with no screening. The cost of mammography varies greatly by strategy and is relevant to screening policy.
The study by O’Donoghue and colleagues is reasonable to consider as they used Medicare reimbursement data. The authors’ simulation model for three different screening practices ($2.6 billion for women aged 50 to 69 years screened every 2 years; $3.5 billion for the USPSTF strategy of personalized screening for women in their 40s and >75 years, plus screening every 2 years for women aged 50-74 years; and $10.1 billion for annual screening starting at age 40 years) seems reasonable, although there can be many variables.
Yearly screening is the most expensive screening method. Biennial mammogram alternating with clinical breast examination is equally effective and the cheapest screening strategy from ages 40 to 75 years. Screening strategies with lower costs and the most benefits should be recommended and considered for implementation in practice, and for future guidelines.
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