The impact of alternative practices on the cost and quality of mammographic screening in the United States

Clinical Breast Cancer
Elizabeth S BurnsideL Esserman

Abstract

The decentralized structure of health care in the Unites States hinders population-based analysis of breast cancer screening. Our objectives are to model mammography in the United States as a whole, to identify the variables that most profoundly affect cost and efficacy, and to develop a strategy to improve mammography screening from a population perspective. A spreadsheet model was used to represent the variables of mammography screening in the United States. The population-based national screening program in Sweden provides a framework for comparison. The outcome measures are the aggregate cost and the number of cancers detected by mammography. We used deterministic sensitivity analysis to calculate the impact of variation in practice. Aggregate costs of screening in the United States are in the range of $3-$5 billion dollars. The percentage of women screened, cost per mammogram, cancer to biopsy ratio, recall rate, and cost of recall have the most profound effect on the quality and cost of a national screening program. Variance of these high-impact variables, based on the U.S. population, modifies the aggregate cost of screening by over $2 billion. As mammography screening in the United States increases to include all women ...Continue Reading

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Citations

Apr 1, 2012·Manufacturing & Service Operations Management : M & SOM·Mehmet U S AyvaciElizabeth S Burnside
Jan 19, 2005·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Jean-Luc Urbain
Sep 26, 2007·Expert Review of Molecular Diagnostics·Laura J EssermanElissa M Ozanne
Apr 8, 2010·The Breast : Official Journal of the European Society of Mastology·Jon M Greif
Apr 10, 2004·Cancer·David GurHoward E Rockette
Dec 25, 2004·Radiology·Steven P PoplackAnna N A Tosteson
Jan 11, 2007·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Amy B KnudsenG Scott Gazelle
Nov 10, 2004·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Robert F WagnerSergey V Beiden
Jul 19, 2014·Drug Metabolism Reviews·Milena Julia SzafraniecLeszek Fiedor
Jul 13, 2011·Breast Cancer Research and Treatment·Gannon KennedyEli Avisar
Jan 1, 2012·American Society of Clinical Oncology Educational Book·Michael AlvaradoLaura Esserman

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