In the last two decades, the death rate from breast cancer has fallen by about seven percent in younger white women. However, in this period African-American women, particularly older African-American women, have experienced a 26 percent increase in mortality, despite having a lower incidence of disease than their white counterparts. For all races of women, mammography screening can potentially reduce mortality by up to 30 percent. Prior cost-effectiveness analyses of breast cancer screening among general population have demonstrated that reduction in mortality can be achieved at a reasonable cost per life year saved. However, there are no data on whether additional expenditures to enhance the cancer control process for African-American women, particularly older African-American women, might affect the overall cost-effectiveness of screening. To address this important gap in our knowledge, we have assembled an experienced multi-disciplinary team of health economists, geriatricians, mathematical modelers, oncologists, health service researchers, decision analysts, and epidemiologists. We will extend prior cost-effectiveness analyses by 1) using existing race-specific data to develop a simulation model of the natural history of disease specific to African-American women ages 50 to 74 years; 2) obtaining primary data on the utilities for breast cancer outcomes among African- Americans to generate quality-adjusted life-years (QALYs) as the outcome of analysis; 3) including non-medical direct (e.g., patient transportation costs, patient time costs); and 4) developing and estimating sub-models which evaluate the incremental costs and effects of programs specifically designed to improve the value of screening in this high-risk population (e.g., programs designed to enhance breast cancer screening use, prompt diagnosis after abnormal screening, and adherence to recommended treatment). We hypothesize that the added costs of targeted cancer control programs for vulnerable African- American women will be offset by the gains in quality-adjusted life years saved as a result of down-staging disease and improving treatment. The results of such analysis will be useful to inform the optimal design of health services delivery programs, and to highlight priority research and service areas to ensure that we reach targeted levels of breast cancer mortality reduction among all women in the US.
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| Mandelblatt, Jeanne S; Kerner, Jon F; Hadley, Jack et al. (2002) Variations in breast carcinoma treatment in older medicare beneficiaries: is it black or white. Cancer 95:1401-14 |
| O'Malley, Ann S; Forrest, Christopher B; Mandelblatt, Jeanne (2002) Adherence of low-income women to cancer screening recommendations. J Gen Intern Med 17:144-54 |
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