Leivo T, Salminen T, Sintonen H, Tuominen R, Auerma K, Partanen K, Saari U, Hakama M, Heinonen O P
Department of Public Health, University of Helsinki, Finland.
Breast Cancer Res Treat. 1999 Apr;54(3):261-7. doi: 10.1023/a:1006136107092.
Double reading is a widely used criterion standard in breast cancer screening despite a lack of evidence of the cost-effectiveness of the second reading. This study evaluates the incremental cost-effectiveness of such a strategy.
Cost-effectiveness analysis: Nationwide population-based semi-annual screening program for women aged 50-59 in Finland. Participation rate was 91%. All mammograms (95,423) performed during 1990-1995 in three screening centers of the Finnish Cancer Society were read by two radiologists with gradings recorded. The effectiveness of the double reading was the difference in cancers detected in the double compared to that of the single reading. Incremental costs of the double reading for the health care and non-health care and the time costs were estimated. The main outcome measure was the incremental cost per additional cancer found as a result of the double-reading strategy.
The total number of cancers detected with the double and single reading were 290 and 261, respectively. A significantly higher ratio of carcinoma in situ was the causative pathology in cancers detected only by the second reader. The cost per cancer detected with a single reading was US$ 18,340. The incremental cost of any additional cancer found was US$ 25,523, that is, a 39% higher cost per additional cancer found by double reading.
The additional cost per cancer detected by double reading is not drastically higher than with single reading. However, the additional cost per life year saved may be much higher.
尽管缺乏二次阅片成本效益的证据，但二次阅片仍是乳腺癌筛查中广泛使用的标准方法。本研究评估了这种策略的增量成本效益。
成本效益分析：针对芬兰50至59岁女性的全国性基于人群的半年一次筛查项目。参与率为91%。1990年至1995年期间在芬兰癌症协会的三个筛查中心进行的所有乳房X光检查（95423例）均由两位放射科医生阅片，并记录分级。二次阅片的有效性是二次阅片与一次阅片相比检测出的癌症差异。估算了二次阅片在医疗保健和非医疗保健方面的增量成本以及时间成本。主要结局指标是二次阅片策略导致每多发现一例癌症的增量成本。
二次阅片和一次阅片检测出的癌症总数分别为290例和261例。原位癌比例显著更高是仅由第二位阅片者检测出的癌症的致病病理。一次阅片检测出一例癌症的成本为18340美元。每多发现一例癌症的增量成本为25523美元，即二次阅片每多发现一例癌症的成本高出39%。
二次阅片检测出每例癌症的额外成本并不比一次阅片高很多。然而，每挽救一个生命年的额外成本可能要高得多。
