Mandelblatt J, Freeman H, Winczewski D, Cagney K, Williams S, Trowers R, Tang J, Gold K, Lin T H, Kerner J
Department of Epidemiology and Biostatistics, Memorial-Sloan-Kettering Cancer Center, New York City, USA.
Am J Public Health. 1997 Jul;87(7):1182-9. doi: 10.2105/ajph.87.7.1182.
This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room.
Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts.
The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen.
Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs.
本研究评估了在公立医院急诊室进行宫颈癌和乳腺癌筛查的成本效益。
由护士为符合年龄条件、病情不紧急且近期未进行筛查的女性提供筛查。一项决策分析比较了急诊室筛查与标准医院筛查工作的成本和结果。
建立新筛查项目时，每挽救一年生命的未贴现成本效益结果为：宫颈癌4050美元、乳腺癌403,203美元、宫颈癌和乳腺癌联合筛查4375美元。如果在现有项目中增加筛查，结果更有利（宫颈癌、乳腺癌和联合筛查每挽救一年生命分别为429美元、21,324美元和479美元）。结果对异常筛查后接受治疗的数量和概率最为敏感。
急诊室筛查对宫颈癌具有成本效益；鉴于接受筛查的女性数量较少，乳腺癌筛查相对昂贵。需要更密集的招募和随访策略，以实现此类项目成本效益的最大化。
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