Cost of Screening Mammography Varies by Strategy

Caroline Helwick

January 2013, Vol 4, No 1 - Health Economics

San Antonio, TX—The national cost of screening mammography could vary by as much as $7 billion annually, depending on the screening strategy, according to a new study reported at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.

“And there is not necessarily a quality benefit for the higher cost,” said Cristina T. O’Donoghue, MD, MPH, lead investigator with the University of California School of Medicine, San Francisco, and the University of Illinois. “We believe that if we follow a strategy that can save costs, we can provide better quality mammography to more women and perhaps reinvest the cost-savings to perform better risk assessment on women aged 40 to 50.”

The optimal mammography screen­ing policy has been controversial, especially with regard to the appropriate age-group and frequency. Resources associated with screening strategies are not well known and are rarely discussed.

“We need to understand the resources that are needed for high- quality mammography, since the Affordable Care Act is estimated to increase the annual demand by 500,000 mammograms,” she said.

Dr O’Donoghue and colleagues estimated the aggregate cost of mammography screening in the United States in 2010, compared the annual costs of the proposed screening strategies, and determined the largest drivers of mammography screening costs. The principal data sources were the Breast Cancer Screening Consortium, the Centers for Disease Control and Prevention, and the Medicare database.

The analysis simulated 4 screening strategies:

  1. Current practice, which screens 61% to 73% of women aged 40 to 84 years
  2. Annual screening, which screens 85% of women aged 40 to 84 years
  3. Biennial screening, which screens 85% of women aged 50 to 69 years
  4. Screening according to the 2009 guidelines of the United States Preventive Services Task Force (USPSTF), which screens high-risk women aged 40 to 49 years (20% of this age-group), 85% of women aged 50 to 69 years, and 37% to 50% of women aged 70 to 84 years and no more than 3 comorbidities.
Annual Cost of Mamography, by Screening Strategy.
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The USPSTF has recommended a change from annual to biennial mammography (with an emphasis on risk-based screening and older age), given that both screening strategies are associated with beneficial mortality reductions, but the negative impact of screening is reduced with biennial screening, Dr O’Donoghue said. “Using the differences in the strategies, we estimated the number of women in 2010 who would be screened, and we looked at their recall rates and other costs associated with mammography. We were able to estimate in 2010 the costs that would accrue.”

The optimal goal, Dr O’Donoghue added, is to screen 85% of the eligible population; current estimates are that 60% to 73% of women are screened.
The estimated cost of the 4 screening policies is outlined in the Figure, with an almost $7-billion difference between the annual and the USPSTF guidelines.
“Modeling the optimal screening participation of 85% of women, the biennial policy proposed by the USPSTF was estimated to cost $6.9 billion less than annual screening,” she reported.

Regarding drivers of cost, Dr O’Donoghue said that the model was most sensitive to the frequency of screening. This was followed by percent screened, mammography cost, and the rate and costs of recalling women for further work-up.
The simple biennial strategy was the least expensive; however, the USPSTF strategy screened more high-risk and healthy older women for a similar cost, she pointed out.

“Of interest, the costs are not just derived by mammography. An annual screening policy obviously costs more, but there are additional costs with recalls and biopsies. Annual programs starting at age 40 to 50 are associated with more false-positives and, therefore, more recalls,” Dr O’Donoghue said.