Incremental cost-effectiveness of double-reading mammograms

Background. Double reading is a widely used criterion standard in breast ca ncer screening despite a lack of evidence of the cost-effectiveness of the second reading. This study evaluates the incremental cost-effectiveness of such a strategy. Design. Cost-effectiveness analysis: Nationwide population-based semi-annua l screening program for women aged 50-59 in Finland. Participation rate was 91%. All mammograms (95,423) performed during 1990-1995 in three screening centers of the Finnish Cancer Society were read by two radiologists with g radings recorded. The effectiveness of the double reading was the differenc e in cancers detected in the double compared to that of the single reading. Incremental costs of the double reading for the health care and non-health care and the time costs were estimated. The main outcome measure was the i ncremental cost per additional cancer found as a result of the double-readi ng strategy. Results. The total number of cancers detected with the double and single re ading were 290 and 261, respectively. A significantly higher ratio of carci noma in situ was the causative pathology in cancers detected only by the se cond reader. The cost per cancer detected with a single reading was US$ 18, 340. The incremental cost of any additional cancer found was US$ 25,523, th at is, a 39% higher cost per additional cancer found by double reading. Conclusions. The additional cost per cancer detected by double reading is n ot drastically higher than with single reading. However, the additional cos t per life year saved may be much higher.