The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.
OBJECTIVE
This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room.


METHODS
Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts.


RESULTS
The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen.


CONCLUSIONS
Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs.
Mandelblatt
J
J
Department of Epidemiology and Biostatistics, Memorial-Sloan-Kettering Cancer Center, New York City, USA.
Freeman
H
H
Winczewski
D
D
Cagney
K
K
Williams
S
S
Trowers
R
R
Tang
J
J
Gold
K
K
Lin
T H
TH
Kerner
J
J
D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008327:Mammography / Q000191:economics; D008403:Mass Screening / Q000191:economics*; D008489:Medical Indigency; D011336:Probability; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics