Mammography screening in Norway: results from the first screening round in four counties and cost-effectiveness of a modeled nationwide screening.

OBJECTIVE: To evaluate whether the results of the first screening round in the Norwegian Breast Cancer Screening Program predict future mortality reduction and to explore the cost-effectiveness of the program. METHODS: The results of surrogate measures were calculated and compared with the targets. A cost-effectiveness analysis was performed assuming a nationwide program starting in 1996 with an attendance rate of 80% and a mortality reduction of 30%. RESULTS: The attendance rate was 79.5% and the detection rate was 0.67%. The proportion of invasive tumors smaller than 15 mm was 53.1%, and 21.7% of the patients who underwent axillary surgery had lymphatic metastasis. The C/E ratios were found to be 3750 US dollars (USD) per year of life saved and 86,045 USD per life saved. CONCLUSION: The results of the first screening round will lead to a mortality reduction of at least 30%. The cost-effectiveness analysis shows that it is possible to run a highly cost-efficient screening program in Norway.

[Cost-effectiveness of mammography screening in Norway]. / Samfunnsøkonomisk lønnsomhet av mammografiscreening i Norge.

Since January 1996, mammography screening every second year has been offered to women aged 50 to 69 in four counties in Norway. As an input to the evaluation of the programme, medical authorities commissioned an analysis of the cost-efficacy of screening. The results are presented in this paper. This study of the screening in the City of Oslo is based on registration of time used on various procedure, data for all procedure performed, and financial accounting data. The result have been recalculated for a simulated nation-wide project. Only costs up to the time of diagnosis (malignant/benign) have been included. The total cost of the Oslo programme 1996/97 was NOK 12.1 m (USD 1.6 m). Cost per women examined was NOK 395 and per cancer detected NOK 57,639. Cost per life saved was estimated at NOK 680,000, per year-of-life saved NOK 30,000. Based on accounting data only, comparisons could be made between counties. Costs in other counties were between 39 and 73% higher than in Oslo. Using an estimate of a 40% higher costs nation-wide, we find that the total cost of one year of nation-wide (population 4.5 m) screening would amount to NOK 83 m, cost per life saved to NOK 950,000, and per year-of-life saved to NOK 41,000. Estimated cost per life saved by traffic safety measures has been NOK 10 m. On this basis, mammography screening in Norway seems to be a highly cost-effective measure.