Digital Breast Tomosynthesis Largely Cost-Effective Compared with Digital Mammography

The use of digital breast tomosynthesis (DBT) decreased false-positive rates while increasing true-negative rates when compared with traditional digital mammography (DM), according to the results of a single-institution study presented at the 2017 San Antonio Breast Cancer Symposium.

Although the overall cost of DBT is higher than DM, researchers observed cost-savings benefits on a per-woman-screened basis for false positives, false negatives, and true negatives.

DBT is increasingly being used as part of breast cancer screening, and initial research has shown it to be cost-effective. However, few studies have focused on the comparative cost-effectiveness of DBT vs DM from a health system perspective.

Emily F Conant, MD, chief of breast imaging at University of Pennsylvania Perelman School of Medicine, and colleagues evaluated all screening at their institution between January 2012 and December 2013. Using screening costs of $155.66 for DM and $215.82 for DBT, they determined overall costs across screening episodes, in addition to costs associated with screenings, follow-up, diagnosis, and cancer treatment.

In total, 52.7% (n = 24,502) of screening episodes used DM and 47.3% (n = 21,981) used DBT. The researchers observed 224 true-positive cases, 29 false-negative cases, 4530 false positive cases, and 41,700 true-negative cases.

Dr Conant and colleagues observed significantly higher rates of true negative (90.9% vs 88.7%; P < .001) and lower false-positive detection (8.6% vs 10.8%; P < .001) with DBT. False negative and true positive rates did not significantly differ.

DBT produced higher overall cost episodes ($378.02 vs $286.62; P < .001), which was driven by the higher average screening costs and follow-up costs (P < .001 for both). The researchers did not observe significant cost differences in the diagnosis or treatment settings.

However, equivalent costs were seen on a per-woman-screened basis for false positives (DBT vs DM, $67.75 vs $65.71), false negatives ($4.63 vs $5.60), and true positives ($85.80 vs $65.15). Only in the true-negative setting were costs significantly higher for DBT on a per-woman-screened basis ($219.84 vs $150.16; P < .001).—Cameron Kelsall