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Cost-effectiveness of detecting breast cancer in lower socioeconomic status African American and Hispanic women through mobile mammography services |
Schweitzer M E, French M T, Ullmann S G, McCoy C B |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology A high-volume versus low-volume mobile mammography programme in the screening of indigent African American and Hispanic population for breast cancer.
Economic study type Cost-effectiveness analysis.
Study population Indigent African American and Hispanic women.
Setting Community. The economic study was carried out in Florida, USA.
Dates to which data relate It was mentioned that the mobile mammography programme in South Florida has been providing screening services to indigent women since 1987. The number of screened women was reported for 1993, 1994 and 1995. The dates related to the effectiveness, resource utilisation and pricedata were not explicitly specified.
Source of effectiveness data The evidence for the final outcomes was based on a single study.
Link between effectiveness and cost data The costing for the low-volume operation was retrospectively undertaken for about 3,600 women screened per year in the study site. The remainder of the costing was based on the South Florida mobile screening programme experience and expert opinion.
Study sample No power calculations were reported. The number of screened women was 3,382, 3,633, and 3,844 in 1993, 1994, and 1995, respectively.
Study design The study was a cohort study. The duration of the follow-up was not reported.
Analysis of effectiveness The primary health outcome was detection rate for women aged 40 and older and aged 50 and older.
Effectiveness results The detection rate for women age 40 and older was 7.5 per 1,000 screened women and for those aged 50 and older was 8.54 per 1,000 screened. Based on those two rates, the number of detections for the low-volume operation (15 screened cases per day) was 28.125 versus 75 cases for the high-volume operation (40 screened cases per day) for women aged 40 and older. The corresponding values forwomen aged 50 and older were 32.025 and 85.4 cases, respectively.
Clinical conclusions The detection rates observed in this study were higher than reported in other screening programmes. According to the authors, the explanation for this phenomenon lies in the high-risk nature of the study population and the fact that most of the screened women in the study had either never, or rarely, had previous breast cancer screening.
Measure of benefits used in the economic analysis The main benefit measure was detection rate for women aged 40 and older and women aged 50 and older.
Direct costs Quantities were reported separately from costs. Cost items were reported separately. The cost calculationsconsisted of fixed costs (including the costs of facilities and operations, staff, and office) and variable costs (including the costs of office, supplies, staff, and maintenance). The cost analysis was performed from the health services perspective. The sources of the data were the South Florida mobile screening programme experience (not clearly defined), expert opinion and a set of assumptions. The date to which the price data referred was not explicitly specified. The costs associated with false positive results were not incorporated in the cost analysis.
Sensitivity analysis A set of sensitivity analyses was performed by examining the effects of a range of feasible operating conditions (from 10 screened woman per day to 55) on the costs, number of detections and cost per detection. The detection rates and cost per detection were also calculated separately for African American, and Hispanic populations for different age groups in the high-volume scenario.
Estimated benefits used in the economic analysis The detection rate for women aged 40 and older, and aged 50 and older was 7.5, and 8.54 per 1,000 screened women, respectively. Based on these two rates, the number of detections for the low-volume operation (15 screened cases per day) was 28.125 versus 75 cases for the high-volume operation (40 screened cases per day) for women aged 40 and older. The corresponding values forwomen aged 50 and older were 32.025 and 85.4 cases, respectively.
Cost results The cost per screened woman for the low-volume operation (14.4 screened cases per day) was S99.49 versus $74.06 for the high-volume operation (40 screened cases per day).
Synthesis of costs and benefits A synthesis was performed by calculating the cost per detection as the measure of cost-effectiveness. The cost per detection for the low-volume operation (15 screened cases per day) was $13,041.08 versus $9,875.27 for the high-volume operation (40 screened cases per day) for women aged 40 and older. The corresponding values forwomen aged 50 and older were $11,452.94 and $8,672.66, respectively. The range of cost per cancer detected in the sensitivity analysis was from about $15,700 for 10 screened cases per day in women older than 40 to about $8,140 for 55 screened cases per day in women older than 50 years of age. The cost per detection for African American women older than 60 with a detection rate of 12.7 per 1,000 was $5,831.85. For Hispanic women younger than 40 with a detection rate of 1.4 per 1,000 the cost per detection was $52,903.22.
Authors' conclusions Mobile mammography offers an important tool in fighting breast cancer for many women who fail to receive regular mammograms. The authors' estimates identify major components of costs in providing mobile mammography services and describe the relationship between volume, selectivity of the screening programme, and cost-effectiveness. Mobile mammography offers major advantages for patients, including increased access and opportunities for cost savings.
CRD COMMENTARY - Selection of comparators An implicit justification was given for the choice of the comparator in that it represented the current experience of the mobile screening programme in the study location.
Validity of estimate of measure of benefit The authors used the same detection rate for both volumes of operation despite accepting the fact that higher volume conditions may create lower detection rate.
Validity of estimate of costs Resource utilisation was reported separately from the costs. Adequate details of cost calculations were given. In the cost analysis, social costs, costs of false positive results, and the trade-off between volume and detection rate were not considered.
Other issues Given the lack of comprehensive sensitivity analysis, and statistical analysis, the results need to be treated with some caution. The authors acknowledged that the results of the study may not be generalisable to other settings or countries.
Source of funding Support provided by the National Institute of Health, National Cancer Institute Grant 1EO1 CA61252-01A1. Support to Dr Schweitzer provided by the McLamore Award in Business and the Social Sciences.
Bibliographic details Schweitzer M E, French M T, Ullmann S G, McCoy C B. Cost-effectiveness of detecting breast cancer in lower socioeconomic status African American and Hispanic women through mobile mammography services. Medical Care Research and Review 1998; 55(1): 99-115 Indexing Status Subject indexing assigned by NLM MeSH Adult; African Americans; Aged; Breast Neoplasms /ethnology /prevention & Cost-Benefit Analysis; Female; Florida; Hispanic Americans; Humans; Mammography /economics /methods; Middle Aged; Mobile Health Units /economics; Poverty; control AccessionNumber 21998008202 Date bibliographic record published 31/03/1999 Date abstract record published 31/03/1999 |
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