Economics of cancer screening programs.

Cancer is a common cause of mortality in the industrialized world. Several forms of the disease are preventable by screening and mass population screening programs have been implemented in many countries. Given the current concern over value for money in healthcare, cancer screening has increasingly attracted the attention of economists. In this review, it is argued that obtaining evidence to demonstrate cost-effectiveness with respect to a novel screening hypothesis is expensive, difficult and time-consuming, with the result that, in the past, screening programs have been implemented on the basis of inadequate evaluation evidence. Over-enthusiastic implementation has led to the institutionalization of inefficient programs, although the tendency to implement too rapidly can be explained by a simple economic model of incentives. Unfortunately, once programs have become established, the economic justification for screening becomes even more difficult to prove.