Saving Lives – A Cost Benefit Analysis

The US Preventive Services Task Force (USPSTF) recently came out with recommendations about routine mammograms. A summary of the recommendation on their website states:

“The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.”

In their report the USPTF acknowledges that routine screenings for women in this age group saves the lives of 1 out of 1,904. It’s clear that one of the reasons for the recommendation was the relative cost of saving those lives.

I wanted to do my own analysis to see what the cost of each saved life would be if those women continued to have mammograms as they do now.

From the Census Bureau website I found an estimate of 22,327,592 for the number of women age 40-49 in 2008. The CDC reported that 63.5% of women in that age group (14,178,021) had a mammogram every 2 years which averages to 7,089,010 mammograms each year. Using the USPSTF number that 1 out of 1,904 mortalities are prevented by the use of mammograms for this age group then 3,723 deaths would be prevented with this number of mammograms each year.

At an average cost of $125, this number of mammograms would cost $886,126,308. I found a statistic that about 8% of mammograms result in an ultrasound follow-up and with an estimated cost of $500; these 567,121 ultrasounds would cost $283,560,418. It was difficult to find a statistic as to how many breast biopsies are performed as a result of a mammogram. For the purpose of this exercise I estimated 2% which would result in 141,780 biopsies performed at an average cost of $3,000 for a total cost of $425,340,628.

The total projected cost of these three screening procedures is $1,595,027,354 which results in a cost of $428,400 for each of the 3,723 deaths that would be prevented. That may sound like a lot of money to the general public, but I would suggest that it does not to the person whose life is saved and their families.

Let’s compare that cost per life saved to the costs of the war in Afghanistan. A Congressional Research Service report dated September 2009 states that the cost of the Afghan war for the period 10/2001 – 9/2010 (includes 2010 appropriation levels) will be $300B. This is before the recent decision to add additional troops.

If you look at the above cost of $428,400 per live saved by breast cancer screening tests, then from the perspective of a cost benefit analysis the $300B needs to have saved 700,280 lives over a 9 year period or about 77,809 lives each year. Keep in mind that this does not include costs for the Iraq war and all of the other activities our country does to “keep us safe” from terrorists.

Can anyone really make the argument that by denying terrorists’ safe haven in Afghanistan (or any country for that matter) that we would save that many American lives each year from terrorist attacks? That doesn’t even account for the fact that the war is actually killing people each year, let alone saving them. It also doesn’t account for the fact that we are maiming thousands of our soldiers and innocent civilians both physically and emotionally. It certainly doesn’t count the costs of caring for so many of our veterans for the rest of their lives.

This cost analysis is not perfect, but it is close enough to ask the question of why we don’t do a cost benefit analysis of our war policy. It should certainly cause us to ask the question as to where our priorities are as a country.

Mark