Costs, evidence, and value in the medicare program: Comment on “the cost of breast cancer screening in the medicare population”
A partir de données portant sur 137 274 femmes d'âge compris entre 66 et 100 ans ayant subi une mammographie dans le cadre du programme Medicare de dépistage du cancer du sein en 2006 et 2007, cette étude évalue les coûts annuels de ce programme, en incluant les dépenses liées au dépistage et aux traitements initiaux
The provocative article by Gross et al published in this issue examines whether investments in new and more expensive breast cancer screening technologies, such as digital mammography, provide a good return on investment in the care of the growing older US female population. Evidence on the efficacy of digital mammography comes from the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial; published in 2005, the trial involved more than 40 000 women of all ages. Digital screening rapidly disseminated into practice in the United States after these results were published. This occurred despite the primary trial finding that there was no overall difference between digital and plain-film mammography in detecting breast cancer, although it was superior for premenopausal or perimenopausal women younger than 50 years with dense breasts. Notably, among women 65 or older, whose breasts have a higher proportion of fat than dense mammary tissue, there was actually a strong trend for digital mammography to perform worse than plain film mammography. Yet Medicare has covered this service under its annual breast cancer screening benefit and continues to do so, despite limitations in evidence of benefit for older women and lack of cost-effectiveness.
JAMA Internal Medicine , commentaire, 2012