Abstract 174P
Background
Controversies exist around the public health benefit of breast cancer (BC) screening. Early detection has proven benefits in terms of improved survival and decreased treatment morbidity. With recent advances in treatment and technologies resulting in increased costs for BC therapy, the cost effectiveness of screening is unknown. The purpose of this study was to use current BC treatment costs to determine cost-effectiveness of mammographic screening.
Methods
Contemporary Canadian cost estimates based on 2023 treatment standards were incorporated into user-created scenarios run on the Canadian Partnership Against Cancer/Statistics Canada OncoSim BC microsimulation model to estimate the impact of various regimens for screening on outcomes and on overall costs of screening and treatment. We ran four scenarios that simulated a birth cohort (aged 40 in 2015) for no screening, biennial screening (ages 50-74 and 40-74), and annual screening (age 40-74).
Results
Canadian per-case BC treatment costs tabulated in our previous work (all values in Canadian dollars, $1 CAD = $0.74 USD = € 0.68) increased markedly from $14,505 for in situ disease, $39,263, $76,446, $97,668 and $370,398 for Stages I through IV respectively. Costs also vary among subtypes; for Stage III, from $75,954 (HER2+) to $110,798 (triple negative) and $117,269 (HR+). Cost per screening mammogram was $71. Our analysis shows that for 1000 women, initially at age 40, the lifetime cost of screening varies from $0 (no screening), $810,000 (biennial 50-74), $1.14M (biennial 40-74) to $2.2M (annual 40-74) while corresponding therapy costs are $14.9M, $12.4M, $11.8M and $10.6M. Number of BC deaths averted per 1000 women screened for each schedule compared to no screening were 9.3, 11.0 and 14.3 respectively (life-years gained 113, 161, 214). Screening annually aged 40-74 is associated with a net savings of $1878/woman or $442.8M annually to the Canadian health system.
Conclusions
Although screening costs rise according to the number of lifetime screens, they are easily offset by reduced breast cancer therapy costs. Increased population level BC screening yields significant net savings to the health system while averting breast cancer deaths.
Editorial acknowledgement
OncoSim is led and supported by the Canadian Partnership Against Cancer, with model development by Statistics Canada, and is made possible through funding from Health Canada. The assumptions and calculations underlying the simulation results were prepared by the author(s), and the responsibility for the use and interpretation of these data and their reporting is entirely that of the authors.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.