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Value analysis of digital breast tomosynthesis for breast cancer screening in a commercially-insured US population

Authors Bonafede M, Kalra VB, Miller J, Fajardo LL

Received 21 October 2014

Accepted for publication 13 November 2014

Published 12 January 2015 Volume 2015:7 Pages 53—63


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Giorgio Lorenzo Colombo

Machaon M Bonafede,1 Vivek B Kalra,2 Jeffrey D Miller,1 Laurie L Fajardo3

1Truven Health Analytics, Cambridge, MA, 2Yale University School of Medicine, New Haven, CT, 3Department of Radiology, University of Iowa College of Medicine, Iowa City, IA, USA

Purpose: The objective of this study was to conduct a value analysis of digital breast tomosynthesis (DBT) for breast cancer screening among women enrolled in US commercial health insurance plans to assess the potential budget impact associated with the clinical benefits of DBT.
Methods: An economic model was developed to estimate the system-wide financial impact of DBT as a breast cancer screening modality within a hypothetical US managed care plan with one million members. Two scenarios were considered for women in the health plan who undergo annual screening mammography, ie, full field digital mammography (FFDM) and combined FFDM + DBT. The model focused on two main drivers of DBT value, ie, the capacity for DBT to reduce the number of women recalled for additional follow-up imaging and diagnostic services and the capacity of DBT to facilitate earlier diagnosis of cancer at less invasive stages where treatment costs are lower. Model inputs were derived from published sources and from analyses of the Truven Health MarketScan® Research Databases (2010–2012). Comparative clinical and economic outcomes were simulated for one year following screening and compared on an incremental basis.
Results: Base-case analysis results show that 4,523 women in the hypothetical million member health plan who are screened using DBT avoid the use of follow-up services. The overall benefit of DBT was calculated at $78.53 per woman screened. Adjusting for a hypothetical $50 incremental cost of the DBT examination, this translates to $28.53 savings per woman screened, or $0.20 savings per member per month across the plan population and an overall cost savings to the plan of $2.4 million per year.
Conclusion: The results of this study demonstrate clinical and economic favorability of DBT for breast cancer screening among commercially-insured US women. Wider adoption of DBT mammography presents an opportunity to deliver value-based care in the US health care system.

Keywords: breast cancer screening, mammography, digital breast tomosynthesis, cost analysis, value analysis, economic model

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