SCREENING MAMMOGRAPHY BEGINNING AT AGE 40 YEARS - A REAPPRAISAL OF COST-EFFECTIVENESS

BACKGROUND, Several recent studies have added significant information regarding the benefit of screening mammography, especially in the 40-4 9-years age group. This new information makes it important to reassess the cost-effectiveness of screening. METHODS. A Markov model was used to study the cost-effectiveness of 4 age-related screening strategies : 1) annually from ages 40-79 years; 2) annually from ages 40-64 years and biennially from ages 65-79 years; 3) annually from ages 40-49 yea rs and biennially from ages 50-79 years; and 4) annually from ages 40- 79 years in high risk women (10%) and biennially from ages 40-49 years followed by annually from ages 50-79 years in normal risk women (90%) . An additional strategy simulating hormone status and estrogen exposu re was evaluated. Cost-effectiveness was expressed as marginal cost pe r year-life saved (MCYLS). RESULTS. The MCYLS varied from $18,800 to $ 16,100. For all strategies this was within the range of other generall y acceptable diagnostic and therapeutic medical procedures. There was a 14% decrease in MCYLS from the least cost-effective to the most cost -effective strategy. CONCLUSIONS. Cost-effectiveness of four age-relat ed mammographic screening strategies was evaluated. The MCYLS for all strategies was within a generally accepted range. With increasing conc erns regarding the cost of health care, this information may be useful in health policy decision-making. (C) 1998 America Cancer Society.