O'Malley M S
UNC Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill 27599-7295.
Am J Prev Med. 1993 May-Jun;9(3):139-45.
The cost-effectiveness of breast cancer screening that includes breast self-examination (BSE) has not been investigated, in part because the costs and effects of programs to teach BSE are not well known. I used data from a randomized, controlled trial and national surveys to compare the benefit, cost, and cost-effectiveness of two one-year, nurse-led programs to teach BSE in a medical practice setting. One program (Mammacare, or MAM) used manufactured silicone models to develop tactile skills; the other program (Traditional, or TRAD) stressed knowledge and examination techniques. I defined benefit as the marginal one-year increase in the number of women in an "average" adult primary care office practice who performed competent and frequent BSE. I defined cost as the marginal increase in the resources used to teach BSE and in the resources used as a result of performing BSE. Cost-effectiveness equaled the cost per competent, frequent BSE examiner added. The "average" practice was derived based on estimates from national surveys of physicians and medical practices. The MAM program's benefit was fivefold greater than the TRAD program's; its total cost was more than threefold greater; and its cost per competent, frequent examiner added was 32% lower. Yet, regardless of the program, one year following teaching only 15%-28% of women were competent, frequent performers. Cost-effectiveness was sensitive to the definition of benefit. Cost-effectiveness was also sensitive to some costs, but generally these sensitivities did not alter the relative cost-effectiveness of the two programs. The cost of teaching BSE was substantial. Benefit, cost, and cost-effectiveness varied by program.(ABSTRACT TRUNCATED AT 250 WORDS)
包括乳房自我检查（BSE）在内的乳腺癌筛查的成本效益尚未得到研究，部分原因是教授BSE的项目的成本和效果尚不清楚。我使用了一项随机对照试验和全国性调查的数据，比较了在医疗实践环境中由护士主导的两个为期一年的教授BSE项目的益处、成本和成本效益。一个项目（乳房关爱项目，或MAM）使用人造硅胶模型来培养触觉技能；另一个项目（传统项目，或TRAD）强调知识和检查技术。我将益处定义为在一个“普通”成人初级保健诊所中能够熟练且频繁进行BSE的女性人数的边际年度增加量。我将成本定义为教授BSE所使用的资源以及因进行BSE而使用的资源的边际增加量。成本效益等于每增加一名能够熟练且频繁进行检查的BSE检查者的成本。“普通”诊所是根据对医生和医疗实践的全国性调查估计得出的。MAM项目的益处比TRAD项目大五倍；其总成本高出三倍多；而每增加一名能够熟练且频繁进行检查的检查者的成本则低32%。然而，无论哪个项目，在教学一年后，只有15% - 28%的女性能够熟练且频繁地进行检查。成本效益对益处的定义很敏感。成本效益对一些成本也很敏感，但总体而言，这些敏感性并没有改变两个项目相对的成本效益。教授BSE的成本很高。益处、成本和成本效益因项目而异。（摘要截选至250字）
