Cost Analysis of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Selected States, 2003-2004

BACKGROUND: Despite the availability and acceptability of breast and cervical cancer screening tests, they may not be affordable, particularly to medically underserved, low-income American women. In response to the lack of affordability of these preventive cancer screening tests, in 1990, the United States Congress passed the Breast and Cervical Cancer Mortality Prevention Act, which established the National Breast and Cervical Early Detection Program (NBCCEDP). The NBCCEDP is the largest organized federally-funded cancer screening program in the United States. In recent years, there has been an emphasis on ascertaining the costs of delivering screening and diagnostic services to the women eligible for the program. OBJECTIVES: To address three short-term NBCCEDP economic-related questions: (1) what is the cost per woman screened or served in the program; (2) what is the cost per woman served by program component; and (3) what is the cost per cancer detected through the program? METHODS: We selected 9 of 68 programs and gathered detailed cost and effectiveness data using standardized data collection tool. Program costs were collected utilizing an activity-based approach. Effectiveness was measured by the number of women screened or served in selected programs. The number of women served included those screened in the program plus those screened outside the program who were referred to the program for diagnostic follow-up of abnormal screening results. Clinical costs included costs of screening and diagnostic services and case management. Data were collected from July 2003 to June 2004 and were analyzed using descriptive statistical methods. We performed sensitivity analysis utilizing second-order Monte Carlo simulation methods to appraise uncertainty in the estimated unit costs. The study was conducted from a program perspective. RESULTS: With in-kind contributions, providing preventive cancer screening services to medically underserved low-income women in 9 programs, was estimated to be $613 per woman served. Without in-kind contributions, the cost was $473. Among program components, screening and coalitions/partnerships accounted for the highest (48.2%) and the lowest (0.5%) cost per woman served respectively. The average cost of screening a woman for breast cancer was $105 and the cost per breast cancer detected was $10,567. The average cost of screening a woman for cervical cancer was $60 and the cost per cervical cancer detected was $13,349. Sensitivity analysis showed some variation in the average costs per woman served or screened. CONCLUSIONS: Costs per woman served, screened, and cancers detected are needed in order for programs to accurately determine the resources required to reach and screen eligible women. With limited program resources, these cost estimates can provide useful information to assist programs in planning and implementing cost-effective activities that could maximize the allocation of program resources. Disclosure information: The findings and conclusions in this abstract are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention (CDC). The authors: Ekwueme DU, Gardner JG, and Tangka FK are employees of the U.S. CDC; and Subramanian S is an employee of RTI International. These authors have no conflict of interest with regard to this research.