Costs, evidence, and value in the medicare program: The challenges of technology innovation in breast cancer prevention and control comment on “the cost of breast cancer screening in the medicare population”
A partir de données issues des registres américains des cancers en 2006 et 2007, cette étude évalue les coûts annuels associés au dépistage du cancer du sein pour le système d'assurance maladie Medicare
The provocative article by Gross et al1 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.2 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.3
JAMA Internal Medicine , commentaire, 2012