Mammograms: Are “Fancy” Ones Cost-Effective?

What You Need to Know: Mammograms are less accurate in women with dense breast tissue. About 10% of women have very dense breasts, while another 40% have some degree of breast density. Tomosynthesis (3D) mammograms appear to be more effective than standard mammograms for women with dense breasts. A new study suggests that tomosynthesis is also cost-effective.

The Study: To investigate whether tomosynthesis would be a clinically effective and cost-effective approach, researchers from Fred Hutchinson Cancer Center (Seattle, USA) used an established breast cancer simulation model to compare biennial screening with digital mammography plus tomosynthesis with mammography only for women 50 to 74 years old. Their model considered costs from the federal (USA) payer perspective, and used a lifetime horizon.

Findings: Adding the second test would result in an incremental cost per quality-adjusted life year (QALY) gained of US$53,893, the researchers found. (Less than US$100,000 per QALY is considered cost-effective.)

For every 2,000 women screened, over 12 rounds of screening, one breast cancer death would be avoided. Adding tomosynthesis to digital mammography would also avoid 405 false-positives for every 1,000 women screened, over 12 rounds of screening.

Tomosynthesis involves taking lower-dose mammography “slices” of the breast using a rotating gantry, and combining them into a loop, author Dr. Christopher Lee explained. “It does require either a new mammography unit or an add-on to an existing mammography unit,” he said. “Most places could just add on a part to their existing digital mammography unit and be able to conduct tomosynthesis, but it is an up-front institutional cost and that is not factored into our analysis.”

Ultrasound for supplemental screening would result in more false positives, while screening magnetic resonance imaging would be prohibitively expensive, the researcher noted.

While research is still in the very early stages, Dr. Lee said, it’s possible that the mammography/tomosynthesis approach might be beneficial for all women, not only those with dense breasts. “This may apply to all women, but we did not study that in this particular analysis,” he said.

He and his colleagues conclude: “Our analysis, conducted by using currently available data, provides women, physicians, payers, and policymakers in the United States with much-needed information regarding the comparative effectiveness of combined mammography and tomosynthesis screening relative to mammography screening alone. Our results suggest that biennial combined screening for women aged 50-74 years with dense breasts is a cost-effective approach from a federal payer perspective if priced appropriately (below a threshold combined screening cost of $226 vs $139 for digital mammography alone) and if interpretive performance metrics of improved specificity are met in routine practice.”

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

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SOURCE:; Radiology 2014.

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Harvard AB Yale MD UPenn Radiation Oncology Radiation Oncologist, Seattle area

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