預防保健的成本效益評估：以乳癌篩檢為例

Objective: Use mammograms as an example to demonstrate the application and limitation of cost-benefit analysis on the preventive care policy of the National Health Insurance of Taiwan. Methods: Use the Cancer Report of the Department of Health (DOH), Disability-Adjusted Life Years (DALY) estimated by Lan and Liang, payment schedule of the Bureau of National Health Insurance (BNHI), and the methods of Maciosek et al. to estimate the benefits and costs of mammograms. Results: Cost-benefit analysis results suggest that a two-step screening strategy can effectively reduce costs and pass the cost-benefit test. High price, low sensitivity, and false positives tend to make it financially unworthy to indiscriminately screen for breast cancer in all women aged 50 to 69 by mammograms. Conclusions: Cost benefit analysis provides a framework for decision-making. Its strength lies in its systematic use of information, thus different opinions can be thoroughly discussed. While a full-scale mammogram does not currently pass the cost-benefit test, the analysis indicates that the expected benefits of screening can be increased through an increase in test sensitivity or a reduction in screening price. We recommend that policy-makers use cost-benefit analysis in the future to systematically examine the potential gains and losses of health care policies.