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How Much Should Screening Mammography Really Cost?

Summary and Comment |
February 10, 2014

How Much Should Screening Mammography Really Cost?

  1. Andrew M. Kaunitz, MD

Models suggest major opportunities to save resources without compromising outcomes.

  1. Andrew M. Kaunitz, MD

Considerable pushback accompanied the 2009 U.S Preventive Services Task Force (USPSTF) screening mammography recommendations (NEJM JW Womens Health Nov 16 2009) Now, investigators have developed models to estimate actual costs (based on Medicare reimbursement) associated with U.S. screening in 2010, as well as those associated with three screening strategies: annual from age 40 to 84, biennial from age 50 to 69, and USPSTF guidance (biennial from age 50 to 74; individualized based on risk from age 40 to 49 and the presence of comorbid conditions at age ≥75).

Estimated costs were US$7.8 billion for actual screening in 2010, $10.1 billion for annual screening, $2.6 billion for biennial screening, and $3.5 billion for USPSTF-recommended screening. Contributing factors were screening frequency, percentage of women screened, percentage of mammograms with digital technology, cost of individual mammography, and number of recalls.

Comment

Editorialists note that these cost estimates are on the low end because Medicare reimburses less than commercial payers; in addition, substantial costs are associated with newer diagnostic breast imaging technologies (e.g., magnetic resonance imaging, tomosynthesis), women's time away from work, and treatment of overdiagnosed cancers. Breast cancer mortality is similar in U.S. and the U.K. even though U.K. women are typically screened every 2 to 3 years. These observations, along with mounting concerns about the efficacy of screening mammography (NEJM JW Womens Health Jan 17 2014), should make us question our current approaches to this common test.

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Agile; Bayer; Merck Equity Vertex Royalties UpToDate Grant / research support Agile; Bayer; Endoceutics; Medical Diagnostic Laboratories; Noven; Teva Editorial boards Contraception; MedScape; Menopause; OBG Management Leadership positions in professional societies North American Menopause Society (Board of Trustees)

Citation(s):

Reader Comments (1)

DONALD RITT Physician, Palliative Medicine, San Diego

I want my daughter screened every 2-3 years. My wife is over 70 and has other problems and does not need to be screened. If this is what I see for my family, that should suffice. There may be reasons for more frequent screening.i.e., FH, other tumors or even excessive anxiety.

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