COST-EFFECTIVENESS OF SHORTENING SCREENING INTERVAL OR EXTENDING AGE RANGE OF NHS BREAST SCREENING-PROGRAM - COMPUTER-SIMULATION STUDY

Objective: To compare the cost effectiveness of two possible modificat ions to the current UK screening programme: shortening the screening i nterval from three to true years and extending the age of invitation t o a final screen from 64 to 69. Design: Computer simulation model whic h first simulates life histories for women in the absence of a screeni ng programme for breast cancer and then assesses haw these life histor ies would be changed by introducing different screening policies. The model was informed by screening and cost data from the NHS breast scre ening programme. Setting: North West region of England. Main outcome m easures: Numbers of deaths prevented, life years gained, and costs. Re sults: Compared with the current breast screening programme both modif ications would increase the number of deaths prevented and the number of life years saved. The current screening policy costs pound 2522 per life year gained; extending the age range of the programme would cost pound 2612 and shortening the interval pound 2709 per life year gaine d: The marginal cost per life year gained of extending the age range o f the screening programme is pound 2990 and of shortening the screenin g interval is pound 3545. Conclusions: If the budget for the NHS breas t screening-programme were to allow for two more invitations per woman , substantial mortality reductions would follow from extending the age range screened or reducing the screening interval. The difference bet ween the two policies is so small that either could be chosen.