Benefits and costs of interventions to improve breast cancer outcomes in African American women.
OBJECTIVE
Historically, African American women have experienced higher breast cancer mortality than white women, despite lower incidence. Our objective was to evaluate whether costs of increasing rates of screening or application of intensive treatment will be off-set by survival benefits for African American women.


METHODS
We use a stochastic simulation model of the natural history of breast cancer to evaluate the incremental societal costs and benefits of status quo versus targeted biennial screening or treatment improvements among African Americans 40 years of age and older. Main outcome measures were number of mammograms, stage, all-cause mortality, and discounted costs per life year saved (LYS).


RESULTS
At the current screening rate of 76%, there is little incremental benefit associated with further increasing screening, and the costs are high: 124,053 US dollars and 124,217 US dollars per LYS for lay health worker and patient reminder interventions, respectively, compared with the status quo. Using reminders would cost 51,537 US dollars per LYS if targeted to virtually unscreened women or 78,130 US dollars per LYS if targeted to women with a two-fold increase in baseline risk. If all patients received the most intensive treatment recommended, costs increase but deaths decrease, for a cost of 52,678 US dollars per LYS. Investments of up to 6,000 US dollars per breast cancer patient could be used to enhance treatment and still yield cost-effectiveness ratios of less than 75,000 US dollars per LYS.


CONCLUSIONS
Except in pockets of unscreened or high-risk women, further investments in interventions to increase screening are unlikely to be an efficient use of resources. Ensuring that African American women receive intensive treatment seems to be the most cost-effective approach to decreasing the disproportionate mortality experienced by this population.
Mandelblatt
Jeanne S
JS
Department of Oncology, Georgetown University Medical Center, and Cancer Control Program, Lombardi Cancer Center, Washington, DC 20007, USA. mandelbj@georgetown.edu
Schechter
Clyde B
CB
Yabroff
K Robin
KR
Lawrence
William
W
Dignam
James
J
Muennig
Peter
P
Chavez
Yoko
Y
Cullen
Jennifer
J
Fahs
Marianne
M
D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D008962:Models, Theoretical; D016019:Survival Analysis