Schrammel P, Griffiths R I, Griffiths C B
Program for Medical Technology and Practice Assessment, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AAOHN J. 1998 Nov;46(11):523-9.
Screening for breast cancer can result in early detection of malignancies and lives saved. Many employers now offer periodic screening as an employee health benefit, and some have established screening programs in the workplace. This study was performed to identify the employer costs of breast cancer screening in the workplace, referrals for suspicious findings, and initial treatment of malignant disease. Additionally, the costs for these same services, had they been obtained outside of a workplace screening program, were estimated. Data on program components and associated costs for an established employer based breast cancer screening program were obtained. These costs were compared to those among a hypothetical cohort of women not enrolled in the workplace screening program. From 1989 through 1995, 1,416 women participated in the program. Nearly 2,500 screening mammograms and approximately 2,773 clinical breast examinations were performed, resulting in 292 referrals to physicians outside of the program for additional diagnostic procedures and treatment as needed. These referrals resulted in the detection of 12 malignancies: 8 Stage I; 3 Stage II; and 1 Stage III. Mammographic and clinical breast examination screening cost $249,041; referrals resulting in benign disease or no detectable disease cost $185,002; and referrals resulting in malignant disease, followed by initial treatment, cost $148,530. Therefore, the total cost was $582,573. Approximately 47% of the cost of referrals and initial treatment were due to employee lost productivity. Total cost in the hypothetical cohort was $1,067,948 under the assumptions that all women received screening outside of the workplace, and that the same number of malignancies were detected at the same stage as in the workplace program. These findings indicate referrals resulting in detection of benign disease or no disease accounted for a substantial proportion of the total cost of the program. In addition, employee lost productivity accounted for almost 50% of the cost of all referrals and initial treatment. Workplace screening is a relatively efficient approach for early detection of breast cancer when compared to off site screening or no screening. The efficiency could be improved with a reduction in the number and cost of unnecessary referrals.
乳腺癌筛查能够实现恶性肿瘤的早期发现并挽救生命。如今，许多雇主将定期筛查作为一项员工健康福利，有些雇主还在工作场所设立了筛查项目。本研究旨在确定工作场所乳腺癌筛查的雇主成本、对可疑检查结果的转诊以及恶性疾病的初始治疗成本。此外，还估算了这些相同服务若在工作场所筛查项目之外获取时的成本。获取了一个既定的基于雇主的乳腺癌筛查项目的组成部分及相关成本数据。将这些成本与未参加工作场所筛查项目的假设女性队列的成本进行了比较。1989年至1995年期间，1416名女性参与了该项目。进行了近2500次乳房X光筛查和大约2773次临床乳房检查，导致292人被转介至项目外的医生处进行额外的诊断程序和必要治疗。这些转介导致发现了12例恶性肿瘤：8例为I期；3例为II期；1例为III期。乳房X光和临床乳房检查筛查花费249,041美元；转介结果为良性疾病或未检测到疾病的花费为185,002美元；转介结果为恶性疾病并随后进行初始治疗的花费为148,530美元。因此，总成本为582,573美元。转介和初始治疗成本的约47%归因于员工生产力损失。在所有女性都在工作场所以外接受筛查且在与工作场所项目相同阶段发现相同数量恶性肿瘤的假设下，假设队列的总成本为1,067,948美元。这些发现表明，导致发现良性疾病或未发现疾病的转介占该项目总成本的很大一部分。此外，员工生产力损失占所有转介和初始治疗成本的近50%。与场外筛查或不筛查相比，工作场所筛查是早期发现乳腺癌的一种相对有效的方法。减少不必要转介的数量和成本可以提高效率。
