Szeto K L, Devlin N J
Ministry of Health, Wellington, New Zealand.
Health Policy. 1996 Nov;38(2):101-15. doi: 10.1016/0168-8510(96)00843-3.
Mammography screening currently represents the only means by which the mortality rate from breast cancer can be modified substantially. A national mammography screening programme is being considered for New Zealand, and pilot programmes were established in two regions (Otago/Southland and Waikato) in 1991 to determine the potential costs and benefits of mammography for New Zealand women. The aim of this paper is to explore the cost-effectiveness of mammography screening in New Zealand relative to no screening, and to examine the marginal change in costs and benefits of altering programme characteristics such as the age of women invited and screening frequency. Cost-effectiveness is measured by the net cost (the costs of screening minus the treatment savings averted by the early detection of cancers) per year of life gained, from the perspective of the public health care sector. A microsimulation computer model, MICROLIFE, was developed to facilitate the estimation of mortality reduction and cost-effectiveness. The results show that, while mammography screening does not 'save money' overall, the cost per year of life saved for a range of policies compares favourably with other New Zealand health services, and is comparable to the results from economic evaluations of mammography screening overseas. Of those regimes considered, screening women 50-64 years of age at 3-yearly intervals appears to be most cost-effective.
目前，乳房X光筛查是唯一能够大幅降低乳腺癌死亡率的手段。新西兰正在考虑开展一项全国性乳房X光筛查计划，1991年在两个地区（奥塔哥/南地和怀卡托）设立了试点项目，以确定乳房X光筛查对新西兰女性的潜在成本和收益。本文的目的是探讨新西兰乳房X光筛查相对于不筛查的成本效益，并研究改变项目特征（如受邀女性年龄和筛查频率）时成本和收益的边际变化。从公共卫生保健部门的角度来看，成本效益通过每获得一年生命的净成本（筛查成本减去因早期发现癌症而避免的治疗费用节省）来衡量。开发了一个微观模拟计算机模型MICROLIFE，以方便估计死亡率降低情况和成本效益。结果表明，虽然乳房X光筛查总体上不会“省钱”，但一系列政策下每挽救一年生命的成本与新西兰其他医疗服务相比具有优势，并且与海外乳房X光筛查的经济评估结果相当。在所考虑的方案中，每三年为50至64岁女性进行一次筛查似乎最具成本效益。
