Cost-effectiveness of mammography screening for breast cancer in a low socioeconomic group of Iranian women.
BACKGROUND
Breast cancer is the most common cancer among women. Mammography screening has been used in many countries to reduce early deaths caused by breast cancer. It is important to ensure that screening programs are effective and efficient. We conducted a study to assess the cost-effectiveness of a national breast cancer screening program implemented in Iran.


METHODS
The perspective of the present study was the health system. Over 26,000 women aged 35 and higher, of low socioeconomic background were recruited from ten cities in the program. We used case-finding as the outcome indicator for assessing effectiveness of the program. We measured the service provision costs, the coordination costs and supervision costs of the program that included the staff costs, and measured cost per detected case. We also conducted sensitivity analyses and calculated false-positive rates as a result of the screening program.


RESULTS
The total cost of breast cancer screening program was estimated at $377,797. The program resulted in the identification of 24 patients with breast cancers, not different from baseline expectations without a screening program. The cost per cancer detected was calculated $15,742. The minimum and maximum cost per breast cancer detected were about $13,524 and $16,947, respectively. We observed a false-positive rate of 7.5% among the target population.


CONCLUSIONS
Our findings suggest that the mammography screening program was not cost-effective. Although there were technical efficiency issues in the conduct of the program, the findings do not support the implementation of national mammography screening programs in Iran in women aged less than 50 years. Careful studies of such programs for higher age groups are also recommended before they are rolled-out nationally.
1)Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2)Health Promotion Research Center, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran.arashidian@tums.ac.ir.
Eshagh
E
Barfar
1)Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 3)Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Arash
A
Rashidian
3)Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. 4)Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Hamed
H
Hosseini
Health Promotion Research Center, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran.
Shirin
S
Nosratnejad
Women's Affairs Office, Ministry of Health and Medical Education, Tehran, Iran.
Esmat
E
Barooti
Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
Kazem
K
Zendehdel
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005189:False Positive Reactions; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007492:Iran; D008327:Mammography / Q000191:economics*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D011203:Poverty; D012923:Social Class