MAMMOGRAPHY SCREENING - AN INCREMENTAL COST-EFFECTIVENESS ANALYSIS OF 2-VIEW VERSUS ONE-VIEW PROCEDURES IN LONDON
MAMMOGRAPHY SCREENING - AN INCREMENTAL COST-EFFECTIVENESS ANALYSIS OF 2-VIEW VERSUS ONE-VIEW PROCEDURES IN LONDON
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DOI：
10.1136/jech.49.1.70
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发表时间：
1995-02-01
影响因子：
6.3
通讯作者：
WARREN, R
中科院分区：
文献类型：
--
作者：
BRYAN, S;BROWN, J;WARREN, R
研究目的：比较单个乳房内侧斜面和两个乳房内侧斜面(内侧斜面加头尾)常规乳房X光检查的成本和效果。设计-在Epping的圣玛格丽特医院进行了一项前瞻性非随机试验，比较单面和双面乳房X光检查的成本和效果。啊，研究中的女性接受了两个视角的乳房X光检查。内侧斜位总是放射科医生首先看到的图像。在临床会议上看完片子后，同一位放射科医生回去一起阅读内侧斜位和头尾侧位，每组片子由两位放射科医生阅读。主要的结果指标是召回率、发现的癌症数量、筛查和评估成本以及成本效益比。受试者-共有26430名妇女参加了使用单面和双面乳房X光检查的乳房筛查。结果：回忆率从一次筛查后的9.1%(2404/26430)下降到两次筛查后的6.7%(1760/26430)。结果还表明，每10000名接受筛查的女性中，通过两次视野筛查可以更早地发现5种癌症。与两个视角筛查相关的额外医疗服务筛查成本估计为3.63英镑：与一个和两个视角筛查政策相关的成本估计分别为41.49英镑和32.99英镑。据估计，每个接受筛查的妇女的私人费用为0.35英镑，每个评估的妇女的私人费用为32.75英镑。计算了两个成本效益比：每检测到额外一种癌症的增量健康服务成本为4129英镑，以及每检测到额外一种癌症的增量健康服务加私人成本为2742英镑。敏感性分析表明，结果对一些参数的较大变化很敏感。这些因素包括筛查成本、评估成本、设备寿命和召回率。结论--使用双视角筛查增加了癌症的早期发现，也增加了成本。两个视图的召回率下降幅度不够大，不足以使两个视图筛选的成本保持中性。虽然这些结果不是完全可概括的，但提供了一个框架，允许其他中心评估在其所在地区进行两种视角筛选的成本效益。
Study objective - To compare the costs and effects of routine mammography screening by a single mediolateral-oblique view and two views (mediolateral-oblique plus craniocaudal) of each breast.Design - A cost effectiveness analysis of a prospective non-randomised trial comparing one and two view mammography screening was carried out at St Margaret's Hospital, Epping. Ah women in the study had two view mammography. The mediolateral-oblique view was always the first image read by the radiologist. After reading the films for a clinic session, the same radiologist then went back and read both the mediolateral-oblique and craniocaudal views together Each set of films was read by two radiologists. The main outcome measures were recall rates, number of cancers detected, screening and assessment costs, and cost effectiveness ratios.Subjects - A total of 26 430 women who attended for breast screening using both one and two view mammography participated. A sample of 132 women attending for assessment provided data on the private costs incurred in attending for assessment.Results - There was a reduction in the recall rate from 9.1% (2404 of 26 430) after one view screening to 6.7% (1760 of 26 430) after two view screening. The results also suggest that for every 10000 women screened an additional five cancers would be detected earlier with two view screening. The additional health service screening cost associated with two view screening was estimated to be pound 3.63: the costs associated with one and two view screening policies were estimated to be pound 41.49 and pound 32.99 respectively. Private costs incurred were estimated to be pound 0.35 per woman screened and pound 32.75 per woman assessed. Two cost effectiveness ratios were calculated: an incremental health service cost per additional cancer detected of pound 4129 and an incremental health service plus private cost per additional cancer detected of pound 2742. The sensitivity analysis suggested that the results were sensitive to relatively large changes in a number of parameters. These included screening costs, assessment costs, equipment life, and recall rates.Conclusions - Use of two view screening increased early cancer detection and also costs. The reduction in the recall rate with two views was not sufficiently large to make the cost of two view screening neutral. While these results are not completely generalisable, a framework is provided to allow other centres to estimate the cost effectiveness of two view screening in their locality.