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The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis

BACKGROUND: Observational studies show that digital breast tomosynthesis (DBT) combined with digital mammography (DM) can reduce recall rates and increases rates of breast cancer detection. The objective of this study was to examine the cost-effectiveness of DBT plus DM versus DM alone in British Co...

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Autores principales: Cressman, Sonya, Mar, Colin, Sam, Janette, Kan, Lisa, Lohrisch, Caroline, Spinelli, John J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CMA Joule Inc. or its licensors 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101637/
https://www.ncbi.nlm.nih.gov/pubmed/33888549
http://dx.doi.org/10.9778/cmajo.20200154
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author Cressman, Sonya
Mar, Colin
Sam, Janette
Kan, Lisa
Lohrisch, Caroline
Spinelli, John J.
author_facet Cressman, Sonya
Mar, Colin
Sam, Janette
Kan, Lisa
Lohrisch, Caroline
Spinelli, John J.
author_sort Cressman, Sonya
collection PubMed
description BACKGROUND: Observational studies show that digital breast tomosynthesis (DBT) combined with digital mammography (DM) can reduce recall rates and increases rates of breast cancer detection. The objective of this study was to examine the cost-effectiveness of DBT plus DM versus DM alone in British Columbia and to identify parameters that can improve the efficiency of breast cancer screening programs. METHODS: We conducted an economic analysis based on data from a cohort of screening participants in the BC Cancer Breast Screening Program. The decision model simulated lifetime costs and outcomes for participants in breast cancer screening who were aged 40–74 years between 2012 and 2017. We analyzed rates of health care resource utilization, health state costs and estimated incremental cost-effectiveness ratios (ICERs), to measure incremental cost differences per quality-adjusted life years (QALYs) gained from the addition of DBT to DM-based screening, from the government payer’s perspective. RESULTS: The model simulated economic outcomes for 112 249 screening participants. We found that the ICER was highly sensitive to recall rate reductions and insensitive to parameters related to cancer detection. If DBT plus DM can reduce absolute recall rates by more than 2.1%, the base-case scenario had an ICER of $17 149 per QALY. At a willingness-to-pay threshold of $100 000 per QALY, more than 95% of the probabilistic simulations favoured the adoption of DBT plus DM versus DM alone. The ICER depended heavily on the ability of DBT plus DM to reduce recall rates. INTERPRETATION: The addition of DBT to DM would be considered cost-effective owing to the low positive predictive value of screening with DM alone. Reductions in false-positive recall rates should be monitored closely.
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spelling pubmed-81016372021-05-07 The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis Cressman, Sonya Mar, Colin Sam, Janette Kan, Lisa Lohrisch, Caroline Spinelli, John J. CMAJ Open Research BACKGROUND: Observational studies show that digital breast tomosynthesis (DBT) combined with digital mammography (DM) can reduce recall rates and increases rates of breast cancer detection. The objective of this study was to examine the cost-effectiveness of DBT plus DM versus DM alone in British Columbia and to identify parameters that can improve the efficiency of breast cancer screening programs. METHODS: We conducted an economic analysis based on data from a cohort of screening participants in the BC Cancer Breast Screening Program. The decision model simulated lifetime costs and outcomes for participants in breast cancer screening who were aged 40–74 years between 2012 and 2017. We analyzed rates of health care resource utilization, health state costs and estimated incremental cost-effectiveness ratios (ICERs), to measure incremental cost differences per quality-adjusted life years (QALYs) gained from the addition of DBT to DM-based screening, from the government payer’s perspective. RESULTS: The model simulated economic outcomes for 112 249 screening participants. We found that the ICER was highly sensitive to recall rate reductions and insensitive to parameters related to cancer detection. If DBT plus DM can reduce absolute recall rates by more than 2.1%, the base-case scenario had an ICER of $17 149 per QALY. At a willingness-to-pay threshold of $100 000 per QALY, more than 95% of the probabilistic simulations favoured the adoption of DBT plus DM versus DM alone. The ICER depended heavily on the ability of DBT plus DM to reduce recall rates. INTERPRETATION: The addition of DBT to DM would be considered cost-effective owing to the low positive predictive value of screening with DM alone. Reductions in false-positive recall rates should be monitored closely. CMA Joule Inc. or its licensors 2021-04-22 /pmc/articles/PMC8101637/ /pubmed/33888549 http://dx.doi.org/10.9778/cmajo.20200154 Text en © 2021 CMA Joule Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Research
Cressman, Sonya
Mar, Colin
Sam, Janette
Kan, Lisa
Lohrisch, Caroline
Spinelli, John J.
The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
title The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
title_full The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
title_fullStr The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
title_full_unstemmed The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
title_short The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
title_sort cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101637/
https://www.ncbi.nlm.nih.gov/pubmed/33888549
http://dx.doi.org/10.9778/cmajo.20200154
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