COST-EFFECTIVENESS OF EXTENDING SCREENING MAMMOGRAPHY GUIDELINES TO INCLUDE WOMEN 40 TO 49 YEARS OF AGE

Background: Screening mammography is recommended for women 50 to 69 ye ars of age because of its proven efficacy and reasonable cost-effectiv eness. Extending screening recommendations to include women 40 to 49 y ears of age remains controversial. Objective: To compare the cost-effe ctiveness of screening mammography in women of different age groups. D esign: Cost-effectiveness analysis done using Markov and Monte Carlo m odels. Patients: General population of women 40 years of age and older . Interventions: Biennial screening from 50 to 69 years of age was com pared with no screening. Screening done every 18 months from ages 40 t o 49 years, followed by biennial screening from ages 50 to 69 years, w as compared with biennial screening from ages 50 to 69 years. Measurem ents: Life-expectancy, costs, and incremental cost-effectiveness. Resu lts: Screening women from 50 to 69 years of age improved life expectan cy by 12 days at a cost of $704 per woman, resulting in a cost-effecti veness 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 d ays 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 s aved. 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 i n women 40 to 49 years of age. Conclusion: The cost-effectiveness of s creening mammography in women 40 to 49 years of age is almost five tim es that in older women. When breast cancer screening policies are bein g set, the incremental cost-effectiveness of extending mammographic sc reening to younger women should be considered.