Program-specific cost-effectiveness analysis: Breast cancer screening policies for a safety-net program

Joy Melnikow, Daniel J Tancredi, Zhuo Yang, Dominique Ritley, Yun Jiang, Christina Slee, Svetlana Popova, Phillip Rylett, Kirsten Knutson, Sherie Smalley

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. Methods A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. Results Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050. Conclusions For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.

Original languageEnglish (US)
Pages (from-to)932-941
Number of pages10
JournalValue in Health
Volume16
Issue number6
DOIs
StatePublished - Sep 2013

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Mammography
Early Detection of Cancer
Cost-Benefit Analysis
Breast Neoplasms
Safety
Costs and Cost Analysis
Mortality
Insurance Claim Review
Neoplasms
Budgets
Life Expectancy
Legislation
Registries
Epidemiology

Keywords

  • breast cancer screening cost-effectiveness analysis health policy safety net programs

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Program-specific cost-effectiveness analysis : Breast cancer screening policies for a safety-net program. / Melnikow, Joy; Tancredi, Daniel J; Yang, Zhuo; Ritley, Dominique; Jiang, Yun; Slee, Christina; Popova, Svetlana; Rylett, Phillip; Knutson, Kirsten; Smalley, Sherie.

In: Value in Health, Vol. 16, No. 6, 09.2013, p. 932-941.

Research output: Contribution to journalArticle

Melnikow, J, Tancredi, DJ, Yang, Z, Ritley, D, Jiang, Y, Slee, C, Popova, S, Rylett, P, Knutson, K & Smalley, S 2013, 'Program-specific cost-effectiveness analysis: Breast cancer screening policies for a safety-net program', Value in Health, vol. 16, no. 6, pp. 932-941. https://doi.org/10.1016/j.jval.2013.06.013
Melnikow, Joy ; Tancredi, Daniel J ; Yang, Zhuo ; Ritley, Dominique ; Jiang, Yun ; Slee, Christina ; Popova, Svetlana ; Rylett, Phillip ; Knutson, Kirsten ; Smalley, Sherie. / Program-specific cost-effectiveness analysis : Breast cancer screening policies for a safety-net program. In: Value in Health. 2013 ; Vol. 16, No. 6. pp. 932-941.
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abstract = "Background Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. Methods A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. Results Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8{\%} at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6{\%}. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6{\%} at an incremental cost per additional life-year of $17,050. Conclusions For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.",
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AU - Melnikow, Joy

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AU - Yang, Zhuo

AU - Ritley, Dominique

AU - Jiang, Yun

AU - Slee, Christina

AU - Popova, Svetlana

AU - Rylett, Phillip

AU - Knutson, Kirsten

AU - Smalley, Sherie

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N2 - Background Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. Methods A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. Results Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050. Conclusions For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.

AB - Background Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. Methods A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. Results Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050. Conclusions For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices.

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