Cost Analysis Supports USPSTF Mammography Guidelines

Cost analysis findings challenge whether annual mammography screening of young women is the best strategy against breast cancer in the USA

medwireNews: Switching to the US Preventive Services Task Force (USPSTF) recommended guidelines for mammography in the USA would save almost US$ 8 billion a year, research suggests.

The American Cancer Society recommends that women over the age of 40 years undergo annual screening, but the USPSTF suggested in 2009 that women should instead receive biennial mammograms from the ages of 50 to 74 years with screening considered for high-risk patients aged 40 to 49 years.

This strategy, mirroring current practices in Europe, has been shown to lower the risk of false–positive results and biopsy without reducing the likelihood of identifying women with later stage breast cancer, explain Laura Esserman, from the University of California, San Francisco, USA, and co-authors.

Using data for 2010, the team found that the USA spent US$ 7.8 billion on screening 70% of women aged 40 to 84 years.

The cost for screening 85% of women in this age group every year was estimated to be US$ 10.1 billion compared with US$ 2.6 billion for biennial screening for all women aged 50 to 69 years, and US$ 3.5 billion for screening following USPSTF guidelines.

Cost analysis showed that the frequency of screening was the largest driver of mammography expense, followed by the proportion of eligible women screened, the use of film versus digital mammography, and the proportion of patients who are recalled and their associated expenses.

“The billions saved from avoiding less-effective mammography screening could alternatively be used to improve women’s health,” say Laura Esserman and co-authors.

Writing in the Annals of Internal Medicine, they suggest that the extra money spent on annual screening from age 40 years would be better used to increase the number of women undergoing regular mammography, improve services for women at high risk of the disease, provide genetic counselling for women with a familial risk and support a European-style public health approach to screening with double reading and outcome tracking.

In an accompanying editorial, Joann Elmore, from the University of Washington in Seattle, and Cary Gross, from Yale University in New Haven, Connecticut, observe that the estimated US$ 8 billion difference in costs between the screening strategies is approximately twice the annual budget of the USA’s National Cancer Institute.

Noting that US physicians are more comfortable with discussing the positives than negatives of screening, they comment: “Everyone should become better educated about the potential benefits, harms, and costs of breast cancer screening options and the important role of patient age and breast cancer risk in moderating the effectiveness of screening”.

“Costs, including out-of-pocket costs, should be part of the conversation because women with high-deductible health plans may find themselves facing a hefty bill for adjunctive imaging tests and procedures,” the editorialists conclude.

Reference

O’Donoghue C, Eklung M, Ozanne E, et al. Aggregate Cost of Mammography Screening in the United States: Comparison of Current Practice and Advocated Guidelines. Ann Intern Med; Advance online publication 4 February 2014. doi:10.7326/M13-1217

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