3D mammograms: fewer false positives, but not cost-effective

  • J Natl Cancer Inst

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Digital breast tomosynthesis (DBT, 3D mammogram) cuts the rate of false-positives by 24%-28% relative to digital mammography (DM), but its additional cost of $56 per exam renders it not cost-effective in the United States. 

Why this matters

  • DBT has been widely adopted since its U.S. introduction in 2011. By 2018, 50% of facilities had a DBT unit.

Study design

  • Three Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models simulated women aged ≥40 years undertaking screening with either DBT or DM beginning in 2011 and continuing for a lifetime.
  • Screening performance relies on observational data on almost 200,000 DM and DBT exams at 3 research centers in the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.
  • Costs were based on 2018 Medicare reimbursement rates of $140.40 for DM and $196.56 for DBT, an additional cost of $56.16.
  • Funding: NIH; other.

Key results

  • In the base case analysis, DBT lowered the rate of false-positive exams by 237-268 per 1000 women, a relative reduction of 24%-28% over DM.
  • DBT had similar rates of mortality, life years, and quality-adjusted life-years (QALYs) compared with DM.
  • DBT's incremental cost-effectiveness ratios ranged from $195,026-$270,135 per QALY gained.

Limitations

  • Reliance on observational data.

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