The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program

Abstract

Objectives To evaluate at which sensitivity digital breast tomosynthesis (DBT) would become cost-effective compared to digital mammography (DM) in a population breast cancer screening program, given a constant estimate of specificity. Methods In a microsimulation model, the cost-effectiveness of biennial screening for women aged 50–75 was simulated for three scenarios: DBT for women with dense breasts and DM for women with fatty breasts (scenario 1), DBT for the whole population (scenario 2) or maintaining DM screening (reference). For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below €20,000 per life year gain (LYG). Results For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8–10.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7–18.7% when DBT sensitivity was at least 80% for scenario 2. At €96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At €80 per DBT, these values decreased to 80% and 90%, respectively. Conclusion DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs. Key Points • DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of €96. • DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of €80. • Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.

Cost-effectiveness of abbreviated-protocol MRI screening for women with mammographically dense breasts in a national breast cancer screening program

“…However, the effectiveness and cost-effectiveness of supplementary ultrasound have been questioned as several studies showed that supplementary ultrasound could only result in limited health gains at substantially increased expenses [ 40 ]. Regarding DBT, a favourable cost-effectiveness in women with dense breast was reported [ 22 , 41 ]. Recently, a study also compared the cost-effectiveness of DBT and AP-MRI in women with dense breasts, and demonstrated that AP-MRI could be a cost-effective alternative to DBT, at an ICER of $20,807 per QALY (at a price of $314 and $214 per screen for AP-MRI and DBT, respectively) [ 42 ].…”

“…This study was reported according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement [ 19 ]. The previously validated micro-simulation model SiMRiSc was used in this analysis [ [20] , [21] , [22] ], the full SiMRiSc code can be accessed on https://fbb-git.gitlab.io/simrisc/ , or https://packages.debian.org/sid/simrisc . Based on the purpose of this study, we updated the related input parameters of the model by searching published data for women with dense breasts.…”

“…Also, false positives were included and if ionizing radiation was applied, the probability of tumour induction was also estimated. A detailed description can be found in previously published studies [ [20] , [21] , [22] , [23] ].…”

Digital Breast Tomosynthesis: Potential Benefits in Routine Clinical Practice

“…Whether DBT could be a cost-effective alternative replacement for DM in a population screening program is a matter of ongoing investigations and depends on the cost to the program. 67 Several studies have shown DBT to be cost-effective, particularly in dense breasts. 68,69 Cost of equipment, availability, storage of data, and ability of biopsy of DBT-only findings are also a consideration in cost-effectiveness to a breast imaging department.…”

Feasibility of a prototype carbon nanotube enabled stationary digital chest tomosynthesis system for identification of pulmonary nodules by pulmonologists

“…Tomosynthesis is a 3-dimensional imaging technique providing reconstruction planes from a limited-angle series of projection images (Figure 1) (25,26). Previous studies of tomosynthesis have demonstrated its ability to deliver fast, low dose, and high-quality images (25,(27)(28)(29)(30).…”