Published Sep 25, 2013

Sacramento, CA, USA — When public health budgets are constrained, mammography screening should begin later and occur less frequently, a cost-effectiveness analysis for California’s Every Woman Counts (EWC) program concludes. As outlined in the article, “Program-Specific Cost-Effectiveness Analysis: Breast Cancer Screening Policies for a Safety-Net Program,” published in Value in Health, the analysis focused on several policy questions, including the effect on EWC program costs and outcomes of starting screening at age 50 years instead of 40 and of screening every two years instead of every year. The study was conducted in response to recent government funding cutbacks. “This was not a clinical recommendation, but rather was intended to help a public health program use its resources to the greatest effectiveness,” said lead author Joy Melnikow, director of the UC Davis Center for Healthcare Policy and Research. The study, conducted by UC Davis and EWC researchers, was based on a sophisticated microsimulation model that projected outcomes based on existing program data. It found that starting mammography screening biennially at age 50 was strongly supported by the model results, given that program funding did not allow screening of the full population of eligible women beginning at age 40. “Because breast cancer incidence goes up with age, using program funds to screen all eligible women over age 50 will have a greater impact on reducing breast cancer deaths,” said Melnikow.  “The goal was to advise a public health program in a timeframe that could be helpful, given that cost-effectiveness analysis typically takes a long time to conduct – often too long to be of use in a quickly changing policy environment.” “This study is important for administrators who are doing their best to run public health programs with limited resources. We found that although it can be challenging, it is by no means impossible to create carefully constructed cost-effectiveness analysis models quickly enough to be useful to programs and policy makers as they render important resource-allocation decisions.” The study also found that  EWC program reimbursement of digital mammography at the standard Medi-Cal rate would impose a very large cost burden on the program budget. Legislation allowing EWC to reimburse at a lower rate will expire in 2014. Funding for the study was provided by the California Program on Access to Care, UC Berkeley School of Public Health in cooperation with the UC Office of the President.  UC Davis Health System Media Contact: Dorsey Griffith (Tel: 916-734-9118).

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