Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To determine whether single reading with Computer-aided detection (CAD) for mammography breast cancer screening by one doctor using CAD is cost-effective compared with standard double reading by two individual doctors.
Method: We established our model with a decision tree and Markov model concept based on feasible screening and clinical pathways, and also with prognosis of the health state transition of breast cancer. Cost-effectiveness analysis was performed using two strategies. The first strategy used double reading, which is the current diagnosis style of mammography screening, by two individual readers who had completed a mammography reading program. The other strategy used was single reading with CAD, and diagnosis was performed by one doctor using CAD. We used expected costs and life years to evaluate cost-effectiveness. Most of the input data were from Miyagi Cancer Society and Miyagi Prefectural Cancer Registry. Other data were from national statistics, the literature, and our hospital. The hypothetical population was 50-year-old women. All costs were from a social perspective and we only dealt with direct medical costs related to breast cancer and CAD installation. One cycle of simulation was 2 years and both cost and effectiveness were discounted by 0.03 annually. Sensitivity analysis was performed to evaluate the robustness of the model and input data.
Result: We found that single reading with CAD reduced expected costs by 7,329 yen and extended expected life years by 0.0065 years compared with double reading. Sensitivity analysis showed that the sensitivity and specificity of CAD and the annual average number of breast cancer screening examinees greatly affected the results.
Conclusion: In summary, single reading using CAD in mammography screening is cost-saving compared with double reading, although the results are highly sensitive to changes in parameters, such as sensitivity and specificity of CAD and the numbers of examinees.
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