MAMMOGRAPHIC SCREENING - MEASUREMENT OF THE COST IN A POPULATION-BASED PROGRAM IN VICTORIA, AUSTRALIA

Study objectives - To estimate the cost per woman participating in a mammographic screening programme, and to describe methods for measuring costs. Design - Expenditure, resource usage, and throughput were monitored over a 12 month period. Unit costs for each phase of the screening process were estimated and linked with the probabilities of each screening outcome to obtain the cost per woman screened and the cost per breast cancer detected. Setting - A pilot, population based Australian programme offering free two-view mammographic screening. Participants - A total of 5986 women aged 50-69 years who lived in the target area, were listed on the electoral roll, had no previous breast cancer, and attended the programme. Results - Unit costs for recruitment, screening, and recall mammography were $17.54, $60.04, and $175.54, respectively. The costs of clinical assessment for women with subsequent clear, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost per woman screened was $117.70, and the cost per breast cancer detected was $11 550. Conclusions - The cost per woman screened is a key variable in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.