Mammographic screening: measurement of the cost in a population based programme in Victoria, Australia

Cost analysis of the National Breast and Cervical Cancer Early Detection Program: selected states, 2003 to 2004

BACKGROUND

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established by the U.S. Congress in 1990. In recent years, there has been an emphasis on ascertaining the NBCCEDP's costs of delivering screening and diagnostic services to medically underserved, low-income women. The objective of this report was to address 3 economic questions: What is the cost per woman served in the program, what is the cost per woman served by program component, and what is the cost per cancer detected through the program?

METHODS

The authors developed a questionnaire to systematically collect activity-based costs on screening for breast and cervical cancer from 9 participating programs. The questionnaire was developed based on well established methods of collecting cost data for program evaluation. Data were collected from July 2003 through June 2004.

RESULTS

With in-kind contributions, the cost of screening services to women in 9 programs was estimated at $555 per woman served. Without in-kind contributions, this cost was $519. Among the program components, screening and coalitions/partnerships accounted for the highest and lowest cost per woman served, respectively. The median cost of screening a woman for breast cancer was $94, and the cost per breast cancer detected was $10,566. For cervical cancer, these costs were $56 and $13,340, respectively.

CONCLUSIONS

Costs per woman served, screened, and cancers detected are needed for programs to accurately determine the resources required to reach and screen eligible women. With limited program resources, these cost estimates can provide useful information to assist programs in planning and implementing cost-effective activities that could maximize the allocation of program resources.

Variation in average costs among federally sponsored state-organized cancer detection programs: economies of scale?

BACKGROUND

Societal cost-effectiveness analysis and its variants help decision makers achieve an efficient allocation of resources across the set of all possible health interventions. Sometimes, however, decision makers are focused instead on the efficient allocation of resources within a particular intervention program that has already been implemented. This is especially true when the intervention is being delivered at several different sites. An analysis of average cost across program sites may help program officials to maximize the health benefits that can be achieved with limited resources. In this article, the authors present such an analysis, with special attention paid to the possible existence and implications of economies of scale.

METHODS

Focusing on federally sponsored, state-organized cancer detection programs, the authors modeled 19 state programs as productive processes and examined their average costs over a 2- to 5-year period of operation. They considered 3 alternative definitions of output: women served, screens performed, and conditions detected. Average federal costs and average total costs were estimated for each grant period. Multivariate regression analysis was used to help explain the variation in average costs.

RESULTS

The average cost estimates were distributed in a skewed pattern with the majority of observations falling close to the median and substantially below the mean. For all measures considered, average cost decreased as output expanded. This inverse relationship between average cost and output level persisted even after controlling for the effects of other predictors, suggesting the possible existence of economies of scale.

DISCUSSION

The potential existence of economies of scale calls into question the assumption of a constant average cost frequently made in economic analyses of proposed public health programs. It also implies that a) differences in output level should be taken into account when comparing operating efficiency across program sites; b) conclusions from societal cost-effectiveness analyses may depend on the level of output at which the programs are evaluated; c) cost projections could be inaccurate if they do not take into account the decrease in average cost that occurs as output expands; and d) gains might be possible if similar programs with limited output potential are integrated, perhaps through cost sharing.

Cost-effectiveness of detecting breast cancer in lower socioeconomic status African American and Hispanic women through mobile mammography services

Lower socioeconomic status African American and Hispanic women suffer from later-stage detection of breast cancer and higher mortality rates than other American women. Low-cost mobile mammography offers one approach to mitigate this problem. This article identifies the economic costs and cost-effectiveness of operating a mobile mammography program targeting indigent populations. Costs are derived from a current mobile mammography service for a range of operating volume conditions and are applied to different detection rates to determine the cost-effectiveness of programs designed to reach different age, racial, and ethnic segments of indigent populations. Results from this work have broad policy implications and form a foundation for future economic and policy analysis in this area.

The effectiveness of mailed patient reminders on mammography screening: a meta-analysis

BACKGROUND

Researchers have tried to increase mammography screening rates by using patient-oriented reminders. This paper compares the effectiveness of mailed patient reminders at increasing mammography screening.

METHODS

Sixteen published articles met the inclusion criteria and were included in the meta-analysis. To assess the association between reminders and mammography screening, the Mantel-Haenszel odds ratio (OR) was calculated.

RESULTS

Among U.S. studies in which controls did not receive any type of reminder, women who received reminders were approximately 50% more likely to get a mammogram (OR 1.48; chi(2)MH(1) = 38.27, P < .001). In addition, tailored letters were found to be more effective than generic reminders (OR 1.87; chi(2)MH(1) = 4.70, P < .05). Combining cost and effectiveness data allowed for estimates of cost per woman screened, which ranged from $0.96 to $5.88.

CONCLUSIONS

Patient reminders are effective at increasing mammography screening. More research is needed to assess (1) the cost-effectiveness of patient reminders and (2) their effectiveness across race, education, income, and type of insurance.

Selection bias from sampling frames: telephone directory and electoral roll compared with door-to-door population census: results from the Blue Mountains Eye Study

Many Australian public health research studies use the telephone directory or the electoral roll as a sampling frame from which to draw study subjects. The sociodemographic, disease-state and risk-factor characteristics of subjects who could be recruited using only the telephone directory or only the electoral roll sampling frames were compared with the characteristics of subjects who would have been missed using only these sampling frames, respectively. In the first phase of the Blue Mountains Eye Study we interviewed and examined 2557 people aged 49 and over living in a defined postcode area, recruited from a door-to-door census. This represented a participation rate of 80.9 per cent and a response rate of 87.9 per cent. The telephone directory was searched for each subject's telephone number and the electoral roll was searched for each subject. Subject characteristics for those who were present in each of these sampling frames were compared with the characteristics of those subjects not included in the sampling frames. The telephone directory listed 2102 (82.2 per cent) of the subjects, and 115 (4.5 per cent) had no telephone connected. The electoral roll contained 2156 (84.3 per cent) of the subjects, and 141 subjects (5.5 per cent) could not be found in either the electoral roll or the telephone directory. Younger subjects, subjects who did not own their own homes and subjects born outside of Australia were significantly less likely to be included in either of these sampling frames. The telephone directory was also more likely to exclude subjects with higher occupational prestige, while the electoral roll was more likely to exclude unmarried persons and males. Researchers using the telephone directory and electoral roll to select subjects for study should be aware of the potential selection bias these sampling frames incur and need to take care when generalising their findings to the wider community.

Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy

OBJECTIVES

To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence.

SETTING

Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990.

METHODS

All relevant resources consumed by the programmes (costs) were listed and measured. The costs are related to 1993. The unit cost for each phase (recruitment, screening, assessment) of the screening process was estimated by dividing the total cost of the phase by the number of women examined. The cost per cancer detected was obtained by dividing the total cost of the programme by the number of cancers detected at screening.

RESULTS

The costs per woman examined were $38.1 and $41.1 in the district and city programmes respectively. The cost per breast cancer detected was $7424 in the district programme and $5180 in the city programme. Staff accounted for more than 50% of the total cost. The unit cost in the screening phase was higher in the district programme, whereas it was lower in the assessment phase.

CONCLUSIONS

Our results are consistent with, although slightly lower than, published estimates of the cost per woman screened. Important parameters for determining the efficiency of a mammographic screening programme are the compliance rate and the recall rate.