Cost-Effectiveness of Increasing Access to Mammography Through Mobile Mammography for Older Women

Authors

  • Arash Naeim MD, PhD,

    1. From the *Multicampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Sepulveda, CaliforniaRAND, Santa Monica, CaliforniaIris Cantor Center for Breast Imaging and School of Public Health, University of California at Los Angeles, Los Angeles, California; and §Swedish Cancer Institute, Seattle, Washington.
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  • Emmett Keeler PhD,

    1. From the *Multicampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Sepulveda, CaliforniaRAND, Santa Monica, CaliforniaIris Cantor Center for Breast Imaging and School of Public Health, University of California at Los Angeles, Los Angeles, California; and §Swedish Cancer Institute, Seattle, Washington.
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  • Lawrence W. Bassett MD,

    1. From the *Multicampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Sepulveda, CaliforniaRAND, Santa Monica, CaliforniaIris Cantor Center for Breast Imaging and School of Public Health, University of California at Los Angeles, Los Angeles, California; and §Swedish Cancer Institute, Seattle, Washington.
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  • Jay Parikh MD,

    1. From the *Multicampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Sepulveda, CaliforniaRAND, Santa Monica, CaliforniaIris Cantor Center for Breast Imaging and School of Public Health, University of California at Los Angeles, Los Angeles, California; and §Swedish Cancer Institute, Seattle, Washington.
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  • Roshan Bastani PhD,

    1. From the *Multicampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Sepulveda, CaliforniaRAND, Santa Monica, CaliforniaIris Cantor Center for Breast Imaging and School of Public Health, University of California at Los Angeles, Los Angeles, California; and §Swedish Cancer Institute, Seattle, Washington.
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  • David B. Reuben MD

    1. From the *Multicampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Sepulveda, CaliforniaRAND, Santa Monica, CaliforniaIris Cantor Center for Breast Imaging and School of Public Health, University of California at Los Angeles, Los Angeles, California; and §Swedish Cancer Institute, Seattle, Washington.
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Address correspondence to Arash Naeim, UCLA Med-Hemat & Onc, Box 957059, Ste 2333 PVUB, Los Angeles, CA 90095-7059. E-mail: anaeim@mednet.ucla.edu

Abstract

OBJECTIVES: To compare the costs of mobile and stationary mammography and examine the incremental cost-effectiveness of using mobile mammography to increase screening rates.

DESIGN: A cost-effectiveness analysis was performed using effectiveness data from a randomized clinical trial and modeling of costs associated with the mobile mammography intervention.

SETTING: The trial involved 60 community-based meal sites, senior centers, and clubs.

PARTICIPANTS: Four hundred ninety-nine individuals were enrolled in the study, of whom 463 had outcome data available for analysis.

MEASUREMENTS: Costs were calculated for stationary and mobile mammography, as well as costs due to differences in technology and film versus digital. Incremental cost-effectiveness (cost per additional screen) was modeled, and sensitivity analysis was performed by altering efficiency (throughput) and effectiveness based on subgroup data from the randomized trial.

RESULTS: The estimated annual costs were $435,162 for a stationary unit, $539,052 for a mobile film unit, and $456, 392 for a mobile digital unit. Assuming mobile units are less efficient (50% annual volume), the cost per screen was $41 for a stationary unit, $86 for a mobile film unit, and $102 for a mobile digital unit. The incremental cost per additional screen were $207 for a mobile film unit and $264 for a mobile digital unit over a stationary unit.

CONCLUSION: Although mobile mammography is a more effective way to screen older women, the absolute cost per screen of mobile units is higher, whereas the reimbursement is no different. Financial barriers may impede the widespread use of this approach.

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