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Cost-Effectiveness of Screening Mammography Beyond Age 75 Years : A Cost-Effectiveness Analysis.

Authors :
Schousboe, John T
Schousboe, John T
Sprague, Brian L
Abraham, Linn
O'Meara, Ellen S
Onega, Tracy
Advani, Shailesh
Henderson, Louise M
Wernli, Karen J
Zhang, Dongyu
Miglioretti, Diana L
Braithwaite, Dejana
Kerlikowske, Karla
Schousboe, John T
Schousboe, John T
Sprague, Brian L
Abraham, Linn
O'Meara, Ellen S
Onega, Tracy
Advani, Shailesh
Henderson, Louise M
Wernli, Karen J
Zhang, Dongyu
Miglioretti, Diana L
Braithwaite, Dejana
Kerlikowske, Karla
Source :
Annals of internal medicine; vol 175, iss 1, 11-19; 0003-4819
Publication Year :
2022

Abstract

BackgroundThe cost-effectiveness of screening mammography beyond age 75 years remains unclear.ObjectiveTo estimate benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years according to comorbidity burden.DesignMarkov microsimulation model.Data sourcesSEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium.Target populationU.S. women aged 65 to 90 years in groups defined by Charlson comorbidity score (CCS).Time horizonLifetime.PerspectiveNational health payer.InterventionScreening mammography to age 75, 80, 85, or 90 years.Outcome measuresBreast cancer death, survival, and costs.Results of base-case analysisExtending biennial mammography from age 75 to 80 years averted 1.7, 1.4, and 1.0 breast cancer deaths and increased days of life gained by 5.8, 4.2, and 2.7 days per 1000 women for comorbidity scores of 0, 1, and 2, respectively. Annual mammography beyond age 75 years was not cost-effective, but extending biennial mammography to age 80 years was ($54 000, $65 000, and $85 000 per quality-adjusted life-year [QALY] gained for women with CCSs of 0, 1, and ≥2, respectively). Overdiagnosis cases were double the number of deaths averted from breast cancer.Results of sensitivity analysisCosts per QALY gained were sensitive to changes in invasive cancer incidence and shift of breast cancer stage with screening mammography.LimitationNo randomized controlled trials of screening mammography beyond age 75 years are available to provide model parameter inputs.ConclusionAlthough annual mammography is not cost-effective, biennial screening mammography to age 80 years is; however, the absolute number of deaths averted is small, especially for women with comorbidities. Women considering screening beyond age 75 years should weigh the potential harms of overdiagnosis versus the potential benefit of averting death from breast cancer.Primary funding sourceNational Cancer Institute and Nation

Details

Database :
OAIster
Journal :
Annals of internal medicine; vol 175, iss 1, 11-19; 0003-4819
Notes :
application/pdf, Annals of internal medicine vol 175, iss 1, 11-19 0003-4819
Publication Type :
Electronic Resource
Accession number :
edsoai.on1391591359
Document Type :
Electronic Resource