Cost-benefit analysis of mammography screening in Denmark based on discrete ranking data

Objective: Economic evaluations such as cost-effectiveness and cost-utility analyses generally fail to incorporate elements of intangible costs and be nefits, such as anxiety and discomfort associated with the screening test a nd diagnostic test, as well as the magnitude of utility associated with a r eduction in the risk of dying from cancer. This paper seeks to include all costs and effects incurred by introducing mammography screening through the application of discrete ranking modeling. Methods: In the present analysis, 207 women were interviewed and asked to r ank, according to priority, a number of alternative breast cancer screening setups. The alternative programs varied with respect to number of tests pe rformed, risk reduction obtained, probability of a false-positive outcome, and extent of copayment. Using discrete ranking modeling, the stated prefer ences were analyzed and the relative weighting of the program attributes id entified. For a range of hypothetical breast cancer programs, relative util ities and corresponding willingness-to-pay estimates were derived. Results: A comparison of cost and willingness to pay for each of the progra ms suggested that net benefits are maximized when screening person aged 50- 74 years biennially. More intensive screening produces lower or similar lev els of utility at a higher cost. Conclusion: Discrete ranking modeling can aid decision making by identifyin g inferior healthcare programs, i.e., programs that are more costly but les s beneficial.