Cost-effectiveness of breast cancer screening

This review reports progress in cost-effectiveness studies in relation to breast cancer screening, and identifies a number of problems which have not been fully solved. One of these is the use of data from different countries. Caution is required when interpreting the results in such circumstances as there are clinical and socio-economic variations which are not well understood. Care must be taken when extrapolating from a trial to a national screening programme because of the additional costs of implementing a national screening programme (e.g. extra qualified staff are required) and there are the differences generated when replicating a research based trial in the form of a service. Attention is drawn to the reliance of cost-effectiveness analysis on clinical results, especially in the form of years of life saved, which in principle depend on lifetime follow up, though this is not yet available from trials of breast cancer screening. The use of measures of morbidity as well as mortality is supported but the variability of estimates of these weights is acknowledged. This is an area for further research, especially because of the recognition of potentially significant psychological aspects in breast cancer screening and treatment. A further point is that any national screening programme does not take place in isolation and the indirect consequence on the demand side are likely in themselves to have resource implications. An example of this is the stimulus to the demand for screening by those outside the proposed screening population. © 1992.