Simulated lifetime costs of three types of employer-based, periodic, breast cancer screening programs for working-age women.
OBJECTIVE
To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost.


METHODS
A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site.


METHODS
Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening.


METHODS
A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death.


METHODS
Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer.


METHODS
The model was used to estimate the mean lifetime cost per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs.


RESULTS
Mean lifetime cost per employee was $5,485 for the On-Site screening program. This cost was significantly (P < .0001) lower than in the Off-Site program (by $311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population.


CONCLUSIONS
Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program.
Griffiths
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Program for Medical Technology and Practice Assessment, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Griffiths
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Powe
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D000328:Adult; D001943:Breast Neoplasms / Q000517:prevention & control*; D003198:Computer Simulation; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics*; D008875:Middle Aged; D009786:Occupational Health Services / Q000191:economics*; D012680:Sensitivity and Specificity