Lindfors Karen K, McGahan Michele C, Rosenquist C John, Hurlock Gregory S
Department of Radiology, University of California, Davis School of Medicine, Suite 3100, 4860 Y St, Sacramento, CA 95817, USA.
Radiology. 2006 Jun;239(3):710-7. doi: 10.1148/radiol.2392050670. Epub 2006 Mar 28.
To analyze the cost-effectiveness of adding computer-aided detection (CAD) to a screening mammography program.
A Markov model was developed to compare three hypothetical groups of women aged 40-79 years. The first group was composed of women undergoing mammographic screening without CAD; the second, of women undergoing mammographic screening with CAD; and the third, of women undergoing observation without screening. Cost-effectiveness was expressed as the marginal cost per year of life saved (MCYLS). MCYLS was calculated for screening mammography with CAD compared with screening mammography alone and for screening mammography alone compared with observation. Sensitivity analyses were performed by varying the cost of CAD, the rates of cancer detection with CAD, and the stage distribution of breast cancers diagnosed with CAD.
Adding CAD to a mammographic screening program resulted in a MCYLS of $19,058. The MCYLS of screening mammography alone compared with observation was $16,023. CAD increases the marginal effectiveness of screening by 29%; however, the marginal cost of screening is also increased by 34%. Varying the cost of CAD yields a linear increase in MCYLS from $8937 with CAD at $9 per case to $24,924 with CAD at $25 per case. The cost-effectiveness of CAD is dependent on the magnitude of the increase in cancer detection rates with CAD but is also affected by the stage distribution of cancers diagnosed with CAD.
The MCYLS is 19% greater for CAD added to screening versus screening mammography alone but is still within the accepted range for cost-effectiveness.
分析在乳腺钼靶筛查项目中添加计算机辅助检测（CAD）的成本效益。
建立马尔可夫模型，比较三组年龄在40 - 79岁的假设女性群体。第一组由接受无CAD乳腺钼靶筛查的女性组成；第二组由接受有CAD乳腺钼靶筛查的女性组成；第三组由接受观察而非筛查的女性组成。成本效益表示为每挽救一年生命的边际成本（MCYLS）。计算了与单独乳腺钼靶筛查相比，添加CAD的乳腺钼靶筛查的MCYLS，以及与观察相比，单独乳腺钼靶筛查的MCYLS。通过改变CAD的成本、CAD的癌症检测率以及CAD诊断的乳腺癌的分期分布进行敏感性分析。
在乳腺钼靶筛查项目中添加CAD导致MCYLS为19,058美元。与观察相比，单独乳腺钼靶筛查的MCYLS为16,023美元。CAD使筛查的边际效果提高了29%；然而，筛查的边际成本也增加了34%。改变CAD的成本会使MCYLS呈线性增加，从每例CAD成本为9美元时的8937美元增加到每例CAD成本为25美元时的24,924美元。CAD的成本效益取决于CAD使癌症检测率增加的幅度，但也受到CAD诊断的癌症的分期分布的影响。
与单独乳腺钼靶筛查相比，在筛查中添加CAD的MCYLS高出19%，但仍在可接受的成本效益范围内。
