Ekwueme Donatus U, Hall Ingrid J, Richardson Lisa C, Gardner James G, Royalty Janet, Thompson Trevor D
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Cancer. 2008 Aug 1;113(3):592-601. doi: 10.1002/cncr.23613.
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) covers the direct clinical costs of breast and cervical cancer screening and diagnostic follow-up for medically underserved, low-income women. Personal costs are not covered. In this report, the authors estimated personal costs per woman participating in NBCCEDP mammography screening by race/ethnicity and also estimated lifetime personal costs (ages 50-74 years).
A decision analysis model was constructed and parameterized by using empiric data from a retrospective cohort survey of mammography rescreening among women ages 50 years to 64 years who participated in the NBCCEDP. Data from 1870 women were collected from 1999 to 2000. The model simulated the flow of resources incurred by a woman participating in the NBCCEDP. The analysis was stratified by annual income into 2 scenarios: Scenario 1, <$10,000; and Scenario 2, from $10,000 to <$20,000. Sensitivity analyses were conducted to appraise uncertainty, and all costs were standardized to 2000 U.S. dollars.
In Scenario 1, for all races/ethnicities, a woman incurred a 1-time cost of $17 and a discounted lifetime cost of $108 for 10 screens and $262 for 25 screens; in Scenario 2, these amounts were $31 and from $197 to $475, respectively. In both scenarios, a non-Hispanic white woman incurred the highest cost. The sensitivity analyses revealed that >70% of cost incurred was attributable to opportunity cost.
Capturing and quantifying personal costs will help ascertain the total cost (ie, societal cost) of providing mammography screening to a medically underserved, low-income woman participating in a publicly funded cancer screening program and, thus, will help determine the true cost-effectiveness of such programs.
国家乳腺癌和宫颈癌早期检测项目（NBCCEDP）涵盖了为医疗服务不足的低收入女性提供乳腺癌和宫颈癌筛查及诊断后续的直接临床费用。个人费用不在覆盖范围内。在本报告中，作者按种族/族裔估算了参与NBCCEDP乳房X线筛查的每位女性的个人费用，并估算了终身个人费用（50 - 74岁）。
构建了一个决策分析模型，并通过对参与NBCCEDP的50至64岁女性进行乳房X线复查的回顾性队列调查的经验数据进行参数化。1999年至2000年收集了1870名女性的数据。该模型模拟了参与NBCCEDP的女性所产生的资源流动情况。分析按年收入分为两种情况：情况1，年收入低于10,000美元；情况2，年收入从10,000美元至低于20,000美元。进行了敏感性分析以评估不确定性，所有费用均按2000年美元进行标准化。
在情况1中，对于所有种族/族裔，一名女性进行10次筛查的一次性费用为17美元，贴现终身费用为108美元，进行25次筛查的贴现终身费用为262美元；在情况2中，这些金额分别为31美元和197美元至475美元。在两种情况下，非西班牙裔白人女性的费用最高。敏感性分析表明，超过70%的费用归因于机会成本。
记录和量化个人费用将有助于确定为参与公共资助癌症筛查项目的医疗服务不足的低收入女性提供乳房X线筛查的总成本（即社会成本），从而有助于确定此类项目的真正成本效益。
