title: Cost-effectiveness of annual versus biennial screening mammography for women with high mammographic breast density.
abstract: OBJECTIVE
  The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50-79 with dense breast tissue.
  
  
  METHODS
  A Markov model was constructed based on screening, diagnostic, and treatment pathways for the population-based screening and cancer care programme in British Columbia, Canada. Model probabilities and screening costs were calculated from screening programme data. Costs for breast cancer treatment were calculated from treatment data, and utility values were obtained from the literature. Incremental cost-effectiveness was expressed as cost per quality adjusted life year (QALY), and probabilistic sensitivity analysis was conducted.
  
  
  RESULTS
  Compared with biennial screening, annual screening generated an additional 0.0014 QALYs (95% CI: -0.0480-0.0359) at a cost of $819 ($ = Canadian dollars) per patient (95% CI: 506-1185), resulting in an incremental cost effectiveness ratio of $565,912/QALY. Annual screening had a 37.5% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY.
  
  
  CONCLUSIONS
  There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated.
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada Cancer Control Research, BC Cancer Agency, Vancouver, Canada.
authors.forename: Reka
authors.initials: R
authors.lastname: Pataky
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ismail
authors.affiliation: Cancer Control Research, BC Cancer Agency, Vancouver, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Coldman
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Elwood
authors.affiliation: Medical Oncology, BC Cancer Agency, Vancouver, Canada Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Gelmon
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada Canadian Health Human Resources Network, Ottawa, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hedden
authors.affiliation: Cancer Control Research, BC Cancer Agency, Vancouver, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Hislop
authors.affiliation: Screening Mammography Program of British Columbia, Vancouver, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kan
authors.affiliation: Breast Cancer Prevention & Risk Assessment Clinic, University of British Columbia, Vancouver, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: McCoy
authors.affiliation: Division of Radiation Oncology, Tom Baker Cancer Centre, and University of Calgary, Calgary, Canada.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada Cancer Control Research, BC Cancer Agency, Vancouver, Canada School of Population and Public Health, University of British Columbia, Vancouver, Canada speacock@bccrc.ca.
authors.forename: Stuart
authors.initials: S
authors.lastname: Peacock
mesh_terms: D001940:Breast / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D001955:British Columbia; D002170:Canada; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods; D008390:Markov Chains; D008875:Middle Aged; D012306:Risk; D012680:Sensitivity and Specificity
keywords: breast density; cost-effectiveness; health economics; screening mammography