1. Comparative Effectiveness in Health Policy Decision Making: A case study of cost- effectiveness analysis for the Every Woman Counts program Joy Melnikow, MD, MPH; Daniel J Tancredi, PhD; Dominique Ritley, MPH; Yun Jiang, MS; Christina Slee, MPH Svetlana Popova, MD, MPH;Philip Rylett, BSc (Hons), RN Kirsten Knutson, MPH;Sherie Smalley, MD Funded by the California Program on Access to Care

2. Impetus Cost-effectiveness analysis (CEA) can project outcomes for public programs and help to allocate limited resources in a more efficient manner. Policy Question: Given the increasing diffusion of more expensive digital mammography, should the EWC program pay for digital mammography to improve access to services?

3. Case Study: EWC Created a simple CEA for California’s Cancer Detection Programs: Every Woman Counts program: Used program-specific data and costs Compared the relative cost-effectiveness of digital and film mammography screening from the payer perspective.

4. Challenges Policy changes during analysis cycle Claims data analysis:  Not structured for connected incidents of care  No outcomes data except cancer registry linkage Balancing rigor and analytic complexity with timeliness

5. Health Policy Implications Simple CEA can provide evidence-based information for policy makers  Requires collaboration for funding, expertise, and data  Standardizing program-specific approaches in the future may help reduce challenges to timeliness and rigor of the models  Once a program-specific model is created, repeated adaptation and application will be more efficient