The Cost-Effectiveness of Screening Mammography Beyond Age 65: A Systematic Review: Table 1.

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Table 1. Summary of Studies on the Cost-Effectiveness of Screening for Breast Cancer after Age 65

Author, Year, Reference	Time Horizon	Type of Model	Interval	Mammography Effectiveness	Sensitivity	Specificity	Costs^a			Utility	Discount Rate	Cost-Effectiveness Ratio^b
Author, Year, Reference	Time Horizon	Type of Model	Interval	Mammography Effectiveness	Sensitivity	Specificity	Screen	Diagnosis	Treatment	Utility	Discount Rate	Cost-Effectiveness Ratio^b
Messecar, 2000³⁰	Lifetime	Markov	Biennial	Based on SEER stage distribution^c	95%	95%	$118	$1,294	$40,475	.8 local .26 mets	5%	3.3 days saved for screening ages 75 -79 (vs ages 65-74) healthy women; 1.5 days saved for women with dementia; cannot abstract CE ratio
Rosenquist and Lindfors, 1998³⁴	ages 40-79	Markov	Annual ages 40-49, biennial ages 50-79	39% reduction in mortality with biennial for 50+; 13% for 40-49 yrs	Not stated	Not stated	$72	$1,116	$7,991 (surgery only)	None	3%	$22,794-$27,248 average CE of screening for ages 50-79^d
Lindfors and Rosenquist, 1995²⁵	ages 40-79	Markov	Annual ages 40-49, biennial ages 50-79	Mortality reduction varies by age; 4%-23% for ages 40-49; 23%-32% for ages 60-79	Not stated	Not stated	$110	$1,116	$7,991 (surgery only)	None	5%	$50,131 for biennial at ages 65-79 (approx vs stopping at age 59)^e
Brown, 1992¹⁰	20 yrs starting at age 50	CANTROL Markov process	Biennial	Observed from RCTs ~30% reduction in mortality	Not stated	98.6%	$99	$2,520	Medicare costs: $21,287 local; $30,714 regional; $30,714 distant; $63,455 terminal care	None	5%	$50,400 for ages 70-75 vs ages 65-70; $54,000 for ages 75-80 vs ages 70-75
Boer et al, 1998³¹	Lifetime	MISCAN	Biennial; examines triennial	Observed from RCTs ~30% reduction in mortality	Varies by lesion size: 40% DCIS; 65% T1a; 80% T1b; 90% T1c; 95% ≥T2	Not stated	$66	National Health Service costs	$34,860 advanced stage	None	6%	$5,910 for ages 65-69 vs stopping at age 64
Boer et al, 1999³³	Lifetime	MISCAN	Biennial; examines annual and triennial	Observed from RCTs ~30% reduction in mortality	Same as Boer et al, 1998³¹	Not stated	$66	National Health Service costs	$34,860 advanced stage	Surgery .89-.93; tam .82; regional .63; mets .29	6%	$48,433 for ages 65-94 vs ages 50-64
de Koning et al, 1991²²	1990-2017	MISCAN	Biennial	Observed from RCTs ~30% reduction in mortality	Same as Boer et al, 1998³¹	Not stated	$66	National Health Service costs	$34,860 advanced stage	None	5%	$13,280 for ages 71-75 vs ages 65-70
Eddy, 1989²⁶	10 yrs	CANTROL Markov process	Annual	Unknown	Not stated	98.6%	$194	Medicare costs: $21,287 local; $30,714 regional; $30,714 distant; $63,455 terminal care	Medicare costs: $21,287 local; $30,714 regional; $30,714 distant; $63,455 terminal care	None	5%	$34,188-$86,614 for screening for ages 65-75
Kerlikowske et al, 1999²⁷	Lifetime	Markov	Biannual	27% reduction in mortality (22%-32%); assume benefits continue for 5 yrs after cessation of screening	Not stated	Not stated	$108-$138	$451	Kaiser HMO costs: $31,258 DCIS; $45,220	None in base case; tested range in sensitivity analysis	3%	$87,887 for ages 70-79 vs stopping at age 69
Mandelblatt et al, 1992³²	Cross section, 1 point in time	Markov	1 point in annual program	Based on SEER stage distribution^c	75%	90%	$146	N/A	N/A	None in base case; tested range in sensitivity analysis: local .9; regional .8; distant .5; short-term false-positive .10	None	Varies by age and health group
CANTROL: a computer program to calculate outcomes (and costs); CE: cost-effectiveness; DCIS: IC ductal carcinoma in-situ; HMO: health maintenance organization; Markov Model: a type of simulation program with recurring defined health states used to portray disease process; Mets: distant metastatic disease (i.e., distant stage); MISCAN: microsimulation of cancer (a Monte Carlo simulation approach); RCT: randomized controlled trials; SEER: Surveillance, Epidemiology, and End Results; Tam: tamoxifen; T1a,b,c: tumor size ^a Year 2002 dollars based on the consumer price index. ^b Incremental costs per additional life-year, compared to screening until age 65, unless otherwise specified. ^cEffectiveness based on stage is estimated by comparing stage distribution in the absence of screening to more favorable stage distribution in the presence of screening. ^dRatio includes annual screening from ages 40-49, so overestimates results for women over age 50. Note that results are average results over the age range and do not allow separation of data for extending screening after age 65. ^eAnalysis includes annual screening from ages 40-64, then biennial from ages 65-79, compared to biennial screening for ages 50-59, so incremental ratio includes costs of starting earlier and extending screening to age 79.

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