Badal Kimberly, Staib James, Tice Jeffrey A, Kim Mi-Ok, Eklund Martin, Wilson Leslie, Dacosta Byfield Stacey, Catlett Kierstin, Maffey Liz, Soonavala Rashna, Shieh Yiwey, Esserman Laura J
Department of Surgery, University of California San Francisco, San Francisco, California, USA
Optum Labs, Eden Prairie, Minnesota, USA.
BMJ Open. 2025 Feb 17;15(2):e089428. doi: 10.1136/bmjopen-2024-089428.
The aim of this study was to estimate the total national direct cost of breast cancer screening from 2019 to 2022 and project the total national cost and average lifetime cost of screening per woman for three current guidelines.
We estimated the national cost of screening from 2019 to 2022, and per cancer detected in 2022, using real-world data on the number of mammograms performed per year. We also projected the national cost of screening using life table modelling for three guidelines: 2021/2023 American College of Radiology (ACR), 2023 American Cancer Society (ACS) and 2024 United States Preventative Services Task Force (USPSTF). The average lifetime cost to screen one woman until age 74 years with each guideline was also estimated. The Optum Labs Data Warehouse was used to estimate commercial and Medicare costs and recall rates. Sensitivity analyses were used to estimate uncertainty and determine which inputs had the largest impact on total national costs.
This study was conducted for the USA.
Women eligible for breast cancer screening.
Digital mammograms (2D) or digital breast tomosynthesis (3D) and/or MRI.
Total national cost of screening calculated as the sum of screening and recall costs. Average lifetime cost of screening per woman until 74 years.
Nationally, screening cost approximately US$11 billion (B) per year from 2019 to 2022 with approximately 37% of eligible women screened each year. In 2022, screening cost US$55 471 per 3D-detected and US$44 000 per 2D-detected invasive or ductal carcinoma in situ case. Using target yearly participation rates of 54%-78% by age of women, the projected cost of screening was US$30B for ACR, US$18B for ACS and US$8B for USPSTF guidelines. The average lifetime cost to screen an average-risk woman was: US$13 416 for ACR, US$7946 for ACS and US$6931 for USPSTF. Participation rates, the proportion of women with a lifetime risk>20% and commercial MRI and 3D costs had the largest impact on total costs.
The cost of screening varies significantly by guideline (US$8B-US$30B) and was most influenced by participation rates, high-risk population proportions and technology costs. Future work can investigate whether risk-based screening strategies being tested in ongoing clinical trials can reduce national screening costs while improving outcomes.Cite Now.
本研究旨在估算2019年至2022年全国乳腺癌筛查的直接总成本，并预测三种现行指南下全国筛查的总成本以及每位女性的平均终生筛查成本。
我们利用每年乳房X线摄影检查数量的真实世界数据，估算了2019年至2022年全国筛查成本以及2022年每例检测出癌症的成本。我们还使用生命表模型预测了三种指南下的全国筛查成本：2021/2023年美国放射学会（ACR）、2023年美国癌症协会（ACS）和2024年美国预防服务工作组（USPSTF）。还估算了按照每种指南对一名女性筛查至74岁的平均终生成本。利用Optum Labs数据仓库估算商业保险和医疗保险成本以及召回率。采用敏感性分析来估算不确定性，并确定哪些投入对全国总成本影响最大。
本研究是针对美国开展的。
符合乳腺癌筛查条件的女性。
数字化乳房X线摄影（2D）或数字化乳腺断层合成（3D）和/或磁共振成像（MRI）。
筛查总成本计算为筛查成本与召回成本之和。每位女性至74岁的平均终生筛查成本。
在全国范围内，2019年至2022年每年筛查成本约为110亿美元（B），每年约37%的符合条件女性接受了筛查。2022年，每例通过3D检测出的浸润性或原位导管癌病例的筛查成本为55471美元，每例通过2D检测出的病例为44000美元。按照各年龄女性54% - 78%的目标年参与率，ACR指南的预测筛查成本为300亿美元，ACS指南为180亿美元，USPSTF指南为80亿美元。对平均风险女性进行筛查的平均终生成本为：ACR指南13416美元，ACS指南7946美元，USPSTF指南6931美元。参与率、终生风险>20%的女性比例以及商业MRI和3D成本对总成本影响最大。
筛查成本因指南不同而有显著差异（80亿美元 - 300亿美元），且受参与率、高风险人群比例和技术成本影响最大。未来的工作可以研究正在进行的临床试验中测试的基于风险的筛查策略是否能够在改善结果的同时降低全国筛查成本。立即引用。
