title: Cost-Effectiveness of Double Reading versus Single Reading of Mammograms in a Breast Cancer Screening Programme.
abstract: OBJECTIVE
  The usual practice in breast cancer screening programmes for mammogram interpretation is to perform double reading. However, little is known about its cost-effectiveness in the context of digital mammography. Our purpose was to evaluate the cost-effectiveness of double reading versus single reading of digital mammograms in a population-based breast cancer screening programme.
  
  
  METHODS
  Data from 28,636 screened women was used to establish a decision-tree model and to compare three strategies: 1) double reading; 2) double reading for women in their first participation and single reading for women in their subsequent participations; and 3) single reading. We calculated the incremental cost-effectiveness ratio (ICER), which was defined as the expected cost per one additionally detected cancer. We performed a deterministic sensitivity analysis to test the robustness of the ICER.
  
  
  RESULTS
  The detection rate of double reading (5.17‰) was similar to that of single reading (4.78‰; P = .768). The mean cost of each detected cancer was €8,912 for double reading and €8,287 for single reading. The ICER of double reading versus single reading was €16,684. The sensitivity analysis showed variations in the ICER according to the sensitivity of reading strategies. The strategy that combines double reading in first participation with single reading in subsequent participations was ruled out due to extended dominance.
  
  
  CONCLUSIONS
  From our results, double reading appears not to be a cost-effective strategy in the context of digital mammography. Double reading would eventually be challenged in screening programmes, as single reading might entail important net savings without significantly changing the cancer detection rate. These results are not conclusive and should be confirmed in prospective studies that investigate long-term outcomes like quality adjusted life years (QALYs).
authors.affiliation: Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Posso
authors.affiliation: Economics Department, Universitat Rovira i Virgili, Reus, Spain.
authors.forename: Misericòrdia
authors.initials: M
authors.lastname: Carles
authors.affiliation: Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Universitat de Lleida, Lleida, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rué
authors.affiliation: Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.|Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.affiliation: Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.|Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bonfill
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods / Q000592:standards; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity