title: Total cost-effectiveness of mammography screening strategies.
abstract: BACKGROUND
  Breast cancer screening technology and treatment have improved over the past decade. This analysis evaluates the total cost-effectiveness of various breast cancer screening strategies in Canada.
  
  
  METHODS
  Using the Wisconsin Cancer Intervention and Surveillance Monitoring Network (CISNET) breast cancer simulation model adapted to the Canadian context, costs and quality-adjusted life years (QALY) were evaluated for 11 mammography screening strategies that varied by start/stop age and screening frequency for the general population. Incremental cost-effectiveness ratios are presented, and sensitivity analyses are used to assess the robustness of model conclusions.
  
  
  RESULTS
  Incremental cost-effectiveness analysis showed that triennial screening at ages 50 to 69 was the most cost-effective at $94,762 per QALY. Biennial ($97,006 per QALY) and annual ($226,278 per QALY) strategies had higher incremental ratios.
  
  
  CONCLUSIONS
  The benefits and costs of screening rise with the number of screens per woman. Decisions about screening strategies may be influenced by willingness to pay and the rate of recall for further examination after positive screens.
authors.affiliation: Health Outcomes and PharmacoEconomic (HOPE) Research Centre at Sunnybrook Research Institute and the University of Toronto.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute.
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Stout
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lee
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin.
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
authors.affiliation: Department of Population Health Sciences and Carbone Cancer Center and the Department of Industrial and Systems Engineering, University of Wisconsin.
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Alagoz
authors.affiliation: Physical Sciences Program, Sunnybrook Research Institute; Departments of Medical Biophysics and Medical Imaging, University of Toronto.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Yaffe
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D002170:Canada; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics*; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity
keywords: Breast screening; economic analysis; microsimulation model; preventive health