Computer-aided Detection of Breast Cancer: A Cost-effectiveness Study

Abstract

To analyze the cost-effectiveness of adding computer-aided detection (CAD) to a screening mammography program. A Markov model was developed to compare three hypothetical groups of women aged 40-79 years. The first group was composed of women undergoing mammographic screening without CAD; the second, of women undergoing mammographic screening with CAD; and the third, of women undergoing observation without screening. Cost-effectiveness was expressed as the marginal cost per year of life saved (MCYLS). MCYLS was calculated for screening mammography with CAD compared with screening mammography alone and for screening mammography alone compared with observation. Sensitivity analyses were performed by varying the cost of CAD, the rates of cancer detection with CAD, and the stage distribution of breast cancers diagnosed with CAD. Adding CAD to a mammographic screening program resulted in a MCYLS of $19,058. The MCYLS of screening mammography alone compared with observation was $16,023. CAD increases the marginal effectiveness of screening by 29%; however, the marginal cost of screening is also increased by 34%. Varying the cost of CAD yields a linear increase in MCYLS from $8937 with CAD at $9 per case to $24,924 with CAD at $25 per case. The cost-effectiveness of CAD is dependent on the magnitude of the increase in cancer detection rates with CAD but is also affected by the stage distribution of cancers diagnosed with CAD. The MCYLS is 19% greater for CAD added to screening versus screening mammography alone but is still within the accepted range for cost-effectiveness.