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January 10, 1996

Cost-effectiveness of Mammography Screening-Reply

Author Affiliations

University of California, Davis Sacramento

JAMA. 1996;275(2):112. doi:10.1001/jama.1996.03530260025023

In Reply.  —We appreciate the opportunity to respond to the provocative comments resulting from publication of our article.Drs Donnelly and Lo are concerned because elements of disutility (anxiety, fear, and the like) were not included in the model. These disutilities are often not analyzed because of the difficulty in assigning values. Positive utilities were also ignored, including knowledge that cancer is not present and establishment of better health habits.Drs Black and Tosteson suggest that we should analyze marginal cost-effectiveness of adding screening of the 40- to 49-year-old age group; this was the subject of a previous article.1 They are correct that the cost-effectiveness of screening in the 40- to 49-year-old age group is highly sensitive to the assumed reduction in mortality. This is illustrated in Table 7 of our article and in the previous study.1We have the following responses to the five concerns about our