Abstract
Purpose: To evaluate the effectiveness of combined biennial digital mammography and tomosynthesis screening, compared with biennial digital mammography screening alone, among women with dense breasts. Materials and Methods: An established, discrete-event breast cancer simulation model was used to estimate the comparative clinical effectiveness and cost-effectiveness of biennial screening with both digital mammography and tomosynthesis versus digital mammography alone among U.S. women aged 50-74 years with dense breasts from a federal payer perspective and a lifetime horizon. Input values were estimated for test performance, costs, and health state utilities from the National Cancer Institute Breast Cancer Surveillance Consortium, Medicare reimbursement rates, and medical literature. Sensitivity analyses were performed to determine the implications of varying key model parameters, including combined screening sensitivity and specificity, transient utility decrement of diagnostic work-up, and additional cost of tomosynthesis. Results: For the base-case analysis, the incremental cost per quality-adjusted life year gained by adding tomosynthesis to digital mammography screening was $53 893. An additional 0.5 deaths were averted and 405 false-positive findings avoided per 1000 women after 12 rounds of screening. Combined screening remained cost-effective (less than $100 000 per quality-adjusted life year gained) over a wide range of incremental improvements in test performance. Overall, cost-effectiveness was most sensitive to the additional cost of tomosynthesis. Conclusion: Biennial combined digital mammography and tomosynthesis screening for U.S. women aged 50-74 years with dense breasts is likely to be cost-effective if priced appropriately (up to $226 for combined examinations vs $139 for digital mammography alone) and if reported interpretive performance metrics of improved specificity with tomosynthesis are met in routine practice.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 772-780 |
| Number of pages | 9 |
| Journal | Radiology |
| Volume | 274 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2015 |
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ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
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Comparative effectiveness of combined digital mammography and tomosynthesis screening for women with dense breasts. / Lee, Christoph I.; Cevik, Mucahit; Alagoz, Oguzhan; Sprague, Brian L.; Tosteson, Anna N A; Miglioretti, Diana L; Kerlikowske, Karla; Stout, Natasha K.; Jarvik, Jeffrey G.; Ramsey, Scott D.; Lehman, Constance D.
In: Radiology, Vol. 274, No. 3, 01.03.2015, p. 772-780.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Comparative effectiveness of combined digital mammography and tomosynthesis screening for women with dense breasts
AU - Lee, Christoph I.
AU - Cevik, Mucahit
AU - Alagoz, Oguzhan
AU - Sprague, Brian L.
AU - Tosteson, Anna N A
AU - Miglioretti, Diana L
AU - Kerlikowske, Karla
AU - Stout, Natasha K.
AU - Jarvik, Jeffrey G.
AU - Ramsey, Scott D.
AU - Lehman, Constance D.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Purpose: To evaluate the effectiveness of combined biennial digital mammography and tomosynthesis screening, compared with biennial digital mammography screening alone, among women with dense breasts. Materials and Methods: An established, discrete-event breast cancer simulation model was used to estimate the comparative clinical effectiveness and cost-effectiveness of biennial screening with both digital mammography and tomosynthesis versus digital mammography alone among U.S. women aged 50-74 years with dense breasts from a federal payer perspective and a lifetime horizon. Input values were estimated for test performance, costs, and health state utilities from the National Cancer Institute Breast Cancer Surveillance Consortium, Medicare reimbursement rates, and medical literature. Sensitivity analyses were performed to determine the implications of varying key model parameters, including combined screening sensitivity and specificity, transient utility decrement of diagnostic work-up, and additional cost of tomosynthesis. Results: For the base-case analysis, the incremental cost per quality-adjusted life year gained by adding tomosynthesis to digital mammography screening was $53 893. An additional 0.5 deaths were averted and 405 false-positive findings avoided per 1000 women after 12 rounds of screening. Combined screening remained cost-effective (less than $100 000 per quality-adjusted life year gained) over a wide range of incremental improvements in test performance. Overall, cost-effectiveness was most sensitive to the additional cost of tomosynthesis. Conclusion: Biennial combined digital mammography and tomosynthesis screening for U.S. women aged 50-74 years with dense breasts is likely to be cost-effective if priced appropriately (up to $226 for combined examinations vs $139 for digital mammography alone) and if reported interpretive performance metrics of improved specificity with tomosynthesis are met in routine practice.
AB - Purpose: To evaluate the effectiveness of combined biennial digital mammography and tomosynthesis screening, compared with biennial digital mammography screening alone, among women with dense breasts. Materials and Methods: An established, discrete-event breast cancer simulation model was used to estimate the comparative clinical effectiveness and cost-effectiveness of biennial screening with both digital mammography and tomosynthesis versus digital mammography alone among U.S. women aged 50-74 years with dense breasts from a federal payer perspective and a lifetime horizon. Input values were estimated for test performance, costs, and health state utilities from the National Cancer Institute Breast Cancer Surveillance Consortium, Medicare reimbursement rates, and medical literature. Sensitivity analyses were performed to determine the implications of varying key model parameters, including combined screening sensitivity and specificity, transient utility decrement of diagnostic work-up, and additional cost of tomosynthesis. Results: For the base-case analysis, the incremental cost per quality-adjusted life year gained by adding tomosynthesis to digital mammography screening was $53 893. An additional 0.5 deaths were averted and 405 false-positive findings avoided per 1000 women after 12 rounds of screening. Combined screening remained cost-effective (less than $100 000 per quality-adjusted life year gained) over a wide range of incremental improvements in test performance. Overall, cost-effectiveness was most sensitive to the additional cost of tomosynthesis. Conclusion: Biennial combined digital mammography and tomosynthesis screening for U.S. women aged 50-74 years with dense breasts is likely to be cost-effective if priced appropriately (up to $226 for combined examinations vs $139 for digital mammography alone) and if reported interpretive performance metrics of improved specificity with tomosynthesis are met in routine practice.
UR - http://www.scopus.com/inward/record.url?scp=84924301210&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84924301210&partnerID=8YFLogxK
U2 - 10.1148/radiol.14141237
DO - 10.1148/radiol.14141237
M3 - Article
C2 - 25350548
AN - SCOPUS:84924301210
VL - 274
SP - 772
EP - 780
JO - Radiology
JF - Radiology
SN - 0033-8419
IS - 3
ER -