Cost-Utility Analysis of Alternative Strategies in Screening for Breast Cancer

Screening for early detection is a primary way to control breast cancer. The choice of effective screening policies involves substantial uncertainty and difficult tradeoffs among medical costs and the duration and quality of life. In this paper, we study the choice of the age at which screening should begin and the frequency of screening tests. These have been issues of important debate in the health policy community. We address these questions using the framework of costutility analysis, as we consider it important to evaluate the outcomes of preventive care in terms of morbidity and quality of life, in addition to survival. After a brief review of background information on breast cancer screening, we introduce cost-utility analysis and its relation with Bayesian decision-making. We then discuss modelling and prior specifications, and carry out a cost-utility evaluation of the currently recommended policy. Finally we compare those to the the Bayes-optimal decision for various values of the exchange rate between dollars and quality of life. We discuss the implications of the results for actual policy decisions.