Extension of the mammographic screening programme in Italy: cost-benefit analysis of early diagnosis in the 45–49 and 70–74 age groups

Le résumé fourni par la source

Extending Italy's mammography screening programme to women aged 45-49 and 70-74 could markedly improve breast-cancer prevention, lowering mortality and optimizing healthcare resources. Using a decision-tree model based on national epidemiological data, we compared the current screening coverage scenario, characterized by a partial regional adoption, with a nationwide optimal coverage extension. Under the current screening coverage scenario, the screening programme covers 1,995,876 eligible women, with a per-patient cost of €9.52. The model estimates 55,663 annual incident cases across the total eligible women, with approximately 13,975 diagnosed at an early stage and 41,688 at an advanced stage. Average disease-management costs amount to €135.84 per patient, resulting in a total per-patient expenditure (screening plus management) of approximately €145.36. The optimal screening coverage scenario extends coverage to the full eligible population of 3,930,936 women, increasing the per-patient cost to €18.75. Extended screening shifts stage distribution toward earlier detection, with approximately 19,430 early-stage cases and 36,233 advanced-stage cases. Per-patient disease-management costs fall to €126.05, for a total per-patient expenditure of approximately €144.80. The near-perfect equivalence between the two scenarios confirms that the intervention is essentially resource-neutral: the additional screening expenditure is almost entirely offset by savings in disease-management costs driven by earlier diagnosis, while enabling the identification of approximately 5,454 additional early-stage cases. Overall, full national extension would require additional investment, almost entirely offsetting costs for the Italian National Health Service (NHS) while improving equity and long-term sustainability through wider access to early diagnosis. Strategies to increase adherence, reduce regional inequalities, and integrate innovative technologies remain crucial, and inclusion of the programme in the Essential Levels of Care (LEA) would guarantee long-term equity and sustainability beyond cost savings.

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