THE COSTS OF MAMMOGRAPHY SCREENING IN NEW-ZEALAND - EVIDENCE FROM THEPILOT PROGRAMS

Aims. To measure the public health service costs associated with New Z ealand's pilot mammography screening programmes. To compare the early evidence on cost per woman screened and per cancer detected in those p rogrammes to that of overseas screening programmes. To estimate the co st of introducing a national screening programme in New Zealand. Metho ds. Costs in each screening centre were obtained by a careful examinat ion of screening budgets and public health service accounts; these wer e inflation adjusted using a consumers price index, and analysed in te rms of equivalent annual operating costs. Results. In the first year o f screening the cost per woman screened (in $1991) was $182 in Waikato and $178 in Otago/Southland. The cost per woman screened in the third year of screening (with an assumed full screening throughput of 8000 women per annum) is estimated to fall to $106 and $113 for the Waikato and Otago/Southland programmes respectively. The cost per cancer dete cted in the first screening round differs between the two programmes. In the first year of screening the cost per cancer detected was $35 97 5 in Waikato and $21 908 in Otago/Southland. The difference was primar ily attributable to a lower cancer detection rate in Waikato in that p eriod (0.51% of women screened compared with 0.81% in Otago/Southland) . Conclusions. The initial performance of the New Zealand pilot progra mmes, both in terms of cost per woman screened and cost per cancer det ected, falls within the range indicated from overseas experience. An e stablished national screening programme is estimated to add between $9 .3 and $9.9 million dollars (in 1991 dollar terms) to health service c osts each year. These costs will be partly offset by savings resulting from the earlier detection of cancers.