MAMMOGRAPHIC SCREENING - MEASUREMENT OF THE COST IN A POPULATION-BASED PROGRAM IN VICTORIA, AUSTRALIA

Study objectives - To estimate the cost per woman participating in a m ammographic screening programme, and to describe methods for measuring costs. Design - Expenditure, resource usage, and throughput were moni tored over a 12 month period. Unit costs for each phase of the screeni ng process were estimated and linked with the probabilities of each sc reening outcome to obtain the cost per woman screened and the cost per breast cancer detected. Setting - A pilot, population based Australia n programme offering free two-view mammographic screening. Participant s - A total of 5986 women aged 50-69 years who lived in the target are a, were listed on the electoral roll, had no previous breast cancer, a nd attended the programme. Results - Unit costs for recruitment, scree ning, and recall mammography were $17.54, $60.04, and $175.54, respect ively. The costs of clinical assessment for women with subsequent clea r, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost pe r woman screened was $117.70, and the cost per breast cancer detected was $11 550. Conclusions - The cost per woman screened is a key variab le in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.