This project, Project 3 of the BSPP, will determine the cost-effectiveness and cost-utility of the interventions developed and implemented in Projects 1 and 2. Three outcomes will be examined to determine the cost- effectiveness and cost-utility of the programs implemented in Lee County, Florida, compared to the full measurement control counties - Indian River, St Lucie and Marin, Florida: participation rates for breast cancer screening; life-years gained; and quality adjusted life-years gained. Participation rates for breast screening will be obtained from Project 1. Breast cancer incidence and stage will be obtained from the Florida Tumor Registry though the Biometry Core. The costs of implementing and maintaining the intervention programs will be obtained from the Administrative and Community Cores. The costs of screening and the costs induced by screening, for evaluation, treatment, follow-up and terminal care of breast cancer, for death from other causes, and for lost time, will be obtained prospectively for randomly selected women with breast cancer and with benign breast disease in the intervention county and the full measurement comparison counties. Quality of life will be measured for women with breast cancer and women with benign breast disease using Kaplan's Quality of Well-Being instrument Sensitivity analyses will examine program development and implementation costs, and the effect of a range of discount rates, estimates of life expectancy, utility values, costs for screening procedures, and costs induced by screening. The costs and effects of Project 2 will also be examined as part of the sensitivity analysis.
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