Abstract
ObjectivesThe usual practice in breast cancer screening programmes for mammogram interpretation is to perform double reading. However, little is known about its cost-effectiveness in the context of digital mammography. Our purpose was to evaluate the cost-effectiveness of double reading versus single reading of digital mammograms in a population-based breast cancer screening programme.MethodsData from 28,636 screened women was used to establish a decision-tree model and to compare three strategies: 1) double reading; 2) double reading for women in their first participation and single reading for women in their subsequent participations; and 3) single reading. We calculated the incremental cost-effectiveness ratio (ICER), which was defined as the expected cost per one additionally detected cancer. We performed a deterministic sensitivity analysis to test the robustness of the ICER.ResultsThe detection rate of double reading (5.17‰) was similar to that of single reading (4.78‰; P = .768). The mean cost of each detected cancer was €8,912 for double reading and €8,287 for single reading. The ICER of double reading versus single reading was €16,684. The sensitivity analysis showed variations in the ICER according to the sensitivity of reading strategies. The strategy that combines double reading in first participation with single reading in subsequent participations was ruled out due to extended dominance.ConclusionsFrom our results, double reading appears not to be a cost-effective strategy in the context of digital mammography. Double reading would eventually be challenged in screening programmes, as single reading might entail important net savings without significantly changing the cancer detection rate. These results are not conclusive and should be confirmed in prospective studies that investigate long-term outcomes like quality adjusted life years (QALYs).
Highlights
Mammogram is the test of choice in European breast cancer screening programmes since it can detect breast cancer at an early stage [1,2,3]
The number of screen detected cancers at double reading was higher in incident screening (n = 104) than in prevalent screening (n = 44)
Compared to incident screening (4.59‰), the cancer detection rate was higher in prevalent screening (7.36‰; P = 0.008)
Summary
Mammogram is the test of choice in European breast cancer screening programmes since it can detect breast cancer at an early stage [1,2,3]. Whereas digital mammography is a technology that can reduce false-positive results, no significant differences in the cancer detection rate were stated when it was compared to screen-film mammography [4]. An evaluation of its costs showed that screening with digital mammography can save long-term budget expense in breast cancer screening programmes [5]. Screening with digital mammography has been widely implemented. Double reading of digital mammograms became the usual practice in European programmes [1]. The following reasons might bring into question its cost-effectiveness
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