Aggregate cost of mammography screening in the United States: comparison of current practice and advocated guidelines

Abstract

Background: Controversy exists over how often and at what age mammography screening should be implemented. Given that evidence supports less frequent screening, the cost differences among advocated screening policies should be better understood.

Objective: To estimate the aggregate cost of mammography screening in the United States in 2010 and compare the costs of policy recommendations by professional organizations.

Design: A model was developed to estimate the cost of mammography screening in 2010 and 3 screening strategies: annual (ages 40 to 84 years), biennial (ages 50 to 69 years), and U.S. Preventive Services Task Force (USPSTF) guidelines (biennial for those aged 50 to 74 years and personalized based on risk for those younger than 50 years and based on comorbid conditions for those 75 years and older).

Setting: United States.

Patients: Women aged 40 to 85 years.

Intervention: Mammography annually, biennially, or following USPSTF guidelines.

Measurements: Cost of screening per year, using Medicare reimbursements.

Results: The estimated cost of mammography screening in the United States in 2010 was $7.8 billion, with approximately 70% of women screened. The simulated cost of screening 85% of women was $10.1 billion, $2.6 billion, and $3.5 billion for annual, biennial, and USPSTF guidelines, respectively. The largest drivers of cost (in order) were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography, and percentage of mammography recalls.

Limitation: Cost estimates and assumptions used in the model were conservative.

Conclusion: The cost of mammography varies by at least $8 billion per year on the basis of screening strategy. The USPSTF guidelines are based on the scientific evidence to date to maximize patient benefit and minimize harm but also result in far more effective use of resources.

Primary funding source: University of California and the Safeway Foundation.

Figure 1

Comparison of the Costs of Screening Strategies per Year. Each bar represents the total cost of mammography screening per year, demarcating the costs from screening mammograms and the subsequent recalls and biopsies.

Figure 2

Sensitivity Analyses of Mammography Screening Practice and Advocated Screening Strategies. Tornado diagrams depicting sensitivity analyses done for the largest determinants of cost for each strategy. The x-axis depicts the cost of mammography screening per year. The bold line within each tornado diagram is the point estimate of cost for each strategy and the horizontal bars represent the impact on cost the input ranges have in the sensitivity analyses. Frequency is the largest driver of cost as demonstrated by the wide range of cost between least frequent strategy, biennial screening, versus the most frequent strategy, annual screening. The next largest drivers of cost, by decreasing level of impact, were: the variation of the percent women screened, the cost of individual mammograms, percent film versus digital mammography, the number of recalls and the recall cost.