Cost-effectiveness analysis for breast cancer screening: double reading versus single plus CAD reading

Computer-aided detection (CAD) increases breast cancer detection, but its cost-effectiveness is unknown for breast cancer screening in Japan. We aimed to determine whether screening mammography diagnosed by one physician using CAD is cost-effective when compared with the standard double reading by two physicians. We established our model with a decision tree and Markov model concept based on feasible screening and clinical pathways, combined with prognosis of the health state transition of breast cancer. Cost-effectiveness analysis between double reading by two readers and single reading with CAD by one reader was performed from a social perspective in terms of the expected cost, life expectancy and incremental cost-effectiveness ratio (ICER). The hypothetical population comprised 50-year-old female breast cancer screening examinees. Only direct medical costs related to breast cancer screening and treatment were considered. One simulation cycle was 2 years, and the annual discount rate was 3 %. Sensitivity analysis was performed to evaluate the robustness of the model and input data. Single reading with CAD increased expected costs by 2,704 yen and extended life expectancy by 0.0087 years compared with double reading. The ICER was 310,805 yen per life year gained, which is below the threshold. Sensitivity analysis showed that the sensitivity and specificity of CAD and the number of breast cancer screening examinees greatly affected the results. Single reading using CAD in mammography screening is more cost-effective than double reading, although the results are highly sensitive to the sensitivity and specificity of CAD and the numbers of examinees.