Another study finds adding tomosynthesis effective at detection and saving money

Digital breast tomosynthesis (DBT) has the potential of saving patients and payers more than $500 million each year, according to a study published Jan. 12 in ClinicoEconomics and Outcomes Research.

Looking to explore the value of DBT as a breast cancer screening modality, the research team, including Machaon M. Bonafede, PhD, MPH, with Truven Health Analytics in Cambridge, Mass., developed an economic model that estimated the financial impact of two screening scenarios—full field digital mammography (FFDM) alone and FFDM plus DBT.

Focusing on the two main drivers of DBT value, the capacity for DBT to reduce recall rates as well as facilitating earlier diagnosis of cancer at less invasive stages where treatment costs would be lower, the researchers created a hypothetical U.S. managed care insurance plan with one million members to run the model against.

“The model calculates the number of women in the health plan requiring follow-up services after their index screening mammography in the FFDM and FFDM + DBT scenarios, respectively,” the authors wrote.

Using an average annual screening rate of 35.5 percent, 85,549 women aged 40 to 75 years made up the patient population for the model. Both scenarios assumed that 100 percent of the model patients participated.

By reducing the FFDM recall rate of 15.35 percent to 10 percent with FFDM and DBT, 4,523 women in the hypothetical health plan screened with DBT avoided follow up services like biopsy and additional imaging.

Total annual cost saving to the hypothetical million-member health plan by adding TBT as a breast cancer screening modality was $2.4 million. This includes $5.5 million savings from avoiding follow-up services and $1.2 million from earlier detection of cancer and less expensive treatments, both of which offset the $4.2 million incremental cost of adding DBT to screening.

This translated to saving $28.53 per screening or $0.20 savings per member per month across the hypothetical health plan.

Bonafede and team noted that mammography practices differ among institutions and recall decisions will vary widely, even among individual radiologists and that the model provided a range of estimates to help account for these variances.

“However, using a conservative estimate that one half of the approximately 39 million mammograms performed annually in the US are for screening (excluding Veterans Administration facilities), then a crude extrapolation of our estimated per patient net cost savings of $28.53 suggests that use of DBT could account for over $550 million saved annually in US breast cancer health care spending if DBT were reimbursed at a rate of $50 more than FFDM,” the researchers wrote.

With 1 in 7 women receiving additional screening after an initial mammogram, the authors concluded that a wider adoption of DBT presents an opportunity to provide cost-effective, value-based care.

“Future research should evaluate the potential impact of DBT from the perspective of patients and/or other types of payers. Investigation of longer-term outcomes is also warranted to better understand the broader clinical and economic implications of adoption of DBT,” Bonafede and colleagues concluded.

A previous study led by Christoph I. Lee, MD, examining combining digital mammography with DBT was covered in Health Imaging and can be found here.