Analyzing Cost-Effectiveness of the Beginning Age of Mammographic Screening

Abstract

This study aimed to perform a cost-effectiveness analysis of mammographic screening in Brazilian women, using a stochastic model, the Markov’s chain. Disease progression was estimated for a hypothetical cohort of 100,000 women in three different scenarios, whose baseline evolution of breast cancer based on the natural history of disease was: (1) the biennial mammography intervention between 50 and 69 years of age; (2) the annual mammographic screening from age 40 and (3) the extension of Scenario 1 up to 80 years old. Costs of the modeled scenarios ranged from R$ 2,969,730.14 for the natural history to R$ 14,660,725.79 for an annual screening starting at age 40. Effectiveness of screening in Scenario 2 (40 years old) was 35.07 years of life gained, equivalent to an extra 9,400 years of life gained when compared with Scenario 1 (50 years old), whose effectiveness was 34.96 years of life gained in the modeled cohort of 100,000 women. The incremental effectiveness is higher in Scenario 1, compared with the natural history of disease. The incremental cost-effectiveness of the strategy in Scenario 1 was R$ 31,111,152.83, and in Scenario 2, R$ 52,910,841.55. Results show that the strategy that presented the best incremental cost-effectiveness ratio, according to the allocated amounts, was from Scenario 1, biennial screening from 50 to 69 years old.