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

Machaon M Bonafede, Vivek B Kalra, Jeffrey D Miller, Laurie L Fajardo, Machaon M Bonafede, Vivek B Kalra, Jeffrey D Miller, Laurie L Fajardo

Abstract

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; cost analysis; digital breast tomosynthesis; economic model; mammography; value analysis.

References

    1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.
    1. Howlader N, Noone AM, Krapcho M, et al., editors. SEER Cancer Statistics Review, 1975–2011. Bethesda, MD, USA: National Cancer Institute; 2014. [Accessed November 17, 2014]. Available from:
    1. Smith RA, Manassaram-Baptiste D, Brooks D, et al. Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2014;64(1):30–51.
    1. Berry DA, Cronin KA, Plevritis SK, et al. Cancer Intervention and Surveillance Modeling Network Collaborators Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353(17):1784–1792.
    1. American Cancer Society . Breast Cancer Facts and Figures 2012. Atlanta, GA, USA: American Cancer Society Inc; 2012. [Accessed October 16, 2014]. Available from: .
    1. American Cancer Society Guidelines for the early detection of cancer. [Accessed October 16, 2014]. Available from: .
    1. American College of Obstetricians and Gynecologists Practice bulletin no 122: breast cancer screening. Obstet Gynecol. 2011;118(2 Pt 1):372–382.
    1. Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society High-Risk Work Group. American Cancer Society Screening Older Women Work Group. American Cancer Society Mammography Work Group. American Cancer Society Physical Examination Work Group. American Cancer Society New Technologies Work Group. American Cancer Society Breast Cancer Advisory Group American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53(3):141–169.
    1. Nelson HD, Tyne K, Naik A, et al. Screening for Breast Cancer: Systematic Evidence Review Update for the US Preventive Services Task Force. Rockville, MD, USA: Agency for Healthcare Research and Quality; 2009. [Accessed October 16, 2014]. (Evidence Review Update No 74. AHRQ Publication No 10-05142-EF-1). Available from:
    1. American Cancer Society . Breast Cancer Facts and Figures 2013–2014. Atlanta, GA, USA: American Cancer Society Inc; 2013. [Accessed October 16, 2014]. Available from: .
    1. Hubbard RA, Zhu W, Horblyuk R, et al. Diagnostic imaging and biopsy pathways following abnormal screen-film and digital screening mammography. Breast Cancer Res Treat. 2013;138(3):879–887.
    1. Newman L. IOM report sets policy priorities for improving breast cancer screening. J Natl Cancer Inst. 2001;93(8):574–575.
    1. Rosenberg RD, Yankaskas BC, Abraham LA, et al. Performance benchmarks for screening mammography. Radiology. 2006;241(1):55–66.
    1. Schell MJ, Yankaskas BC, Ballard-Barbash R, et al. Evidence-based target recall rates for screening mammography. Radiology. 2007;243(3):681–689.
    1. Agency for Healthcare Research and Quality (AHRQ) Imaging efficiency: percentage of patients with mammography screening studies that are followed by a diagnostic mammography, ultrasound or MRI of the breast in an outpatient or office setting within 45 days. Measure Summary NQMC-8949. May 7, 2014. [Accessed October 16, 2014]. Available from: .
    1. Rauscher GH, Murphy AM, Orsi JM, Dupuy DM, Grabler PM, Weldon CB. Beyond the mammography quality standards act: measuring the quality of breast cancer screening programs. AJR Am J Roentgenol. 2014;202(1):145–151.
    1. Smith A. Tomosynthesis: the use of breast tomosynthesis in a clinical setting. Bedford, MA, USA: Hologic, Inc; Jun, 2012. 2012. [Accessed October 16, 2014]. (White paper WP-00060 Rev 002). Available from: .
    1. US Food and Drug Administration Selenia Dimensions 3D System–P080003. [Accessed October 16, 2014]. Available from: .
    1. Smith A. Full-field breast tomosynthesis. Radiol Manage. 2005;27(5):25–31.
    1. Destounis S, Arieno A, Morgan R. Initial experience with combination digital breast tomosynthesis plus full field digital mammography or full field digital mammography alone in the screening environment. J Clin Imaging Sci. 2014;4:9.
    1. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 2013;267(1):47–56.
    1. Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013;14(7):583–589.
    1. Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R., Jr Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol. 2013;200(6):1401–1408.
    1. Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE. Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology. 2013;269(3):694–700.
    1. Conant E, Wan F, Thomas M, et al. Implementing digital breast tomosynthesis (DBT) in a screening population: PPV1 as a measure of outcome; Abstract presented at the Radiological Society of North America Scientific Assembly and Annual Meeting; Chicago, IL, USA. December 1–6, 2013; [Accessed October 16, 2014]. Available from: .
    1. Greenberg JS, Javitt MC, Katzen J, Michael S, Holland AE. Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. AJR Am J Roentgenol. 2014;203(3):687–693.
    1. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499–2507.
    1. Kalra V, Haas B, Forman H, Philpotts L. Cost-effectiveness of digital breast tomosynthesis; Abstract presented at the Radiological Society of North America Scientific Assembly and Annual Meeting; Chicago, IL, USA. November 25–30, 2012; [Accessed October 16, 2014]. Available from: .
    1. Kalra V, Haas B, Philpotts L. Cost-effectiveness of tomosynthesis in screening mammography: analysis by breast density and patient age; Abstract presented at the Radiological Society of North America Scientific Assembly and Annual Meeting; Chicago, IL, USA. December 1–6, 2013; [Accessed October 16, 2014]. Available from: .
    1. Elmore JG, Nakano CY, Koepsell TD, Desnick LM, D’Orsi CJ, Ransohoff DF. International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst. 2003;95(18):1384–1393.
    1. Truven Health Analytics, Inc Truven Health Analytics MarketScan® Research Databases. [Accessed October 16, 2014]. Available from: .
    1. Bonafede MM, Miller JD, Lenhart GM, Nelson J, Fajardo LL. Health insurer burden of patient recall following breast cancer screening mammography. Value Health. 2014;17(3):A82.
    1. Tice JA, Ollendorf DA, Lee JM, Pearson SD. The comparative clinical effectiveness and value of supplemental screening test following negative mammography in women with dense breast tissue. San Francisco, CA, USA: California Technology Assessment Forum; Nov 4, 2013. [Accessed October 16, 2014]. (California Technology Assessment Forum). Available from: .
    1. Sickles EA, D’Orsi CJ, Bassett LW, et al. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, USA: American College of Radiology; 2013. ACR BI-RADS® mammography.
    1. Partridge AH, Hughes ME, Ottesen RA, et al. The effect of age on delay in diagnosis and stage of breast cancer. Oncologist. 2012;17(6):775–782.
    1. Skaane P, Bandos AI, Gullien R, et al. Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration. Eur Radiol. 2013;23(8):2061–2071.
    1. Mittmann N, Isogai PK, Saskin R, et al. Population-based health care cost estimates related to breast cancer by staging. J Clin Oncol. 2011;29(Suppl 15):6108.
    1. Legorreta AP, Brooks RJ, Leibowitz AN, Solin LJ. Cost of breast cancer treatment. A 4-year longitudinal study. Arch Intern Med. 1996;156(19):2197–2201.
    1. Lindfors KK, McGahan MC, Rosenquist CJ, Hurlock GS. Computer-aided detection of breast cancer: a cost-effectiveness study. Radiology. 2006;239(3):710–717.
    1. Elmore JG, Gross CP. The cost of breast cancer screening in the United States: a picture is worth … a billion dollars? Ann Intern Med. 2014;160(3):203.
    1. Barlow WE, Chi C, Carney PA, et al. Accuracy of screening mammography interpretation by characteristics of radiologists. J Natl Cancer Inst. 2004;96(24):1840–1850.
    1. US Food and Drug Administration Mammography Quality Standards Act and Program, National Statistics. Total annual mammography procedures reported, as of June 1, 2014. [Accessed October 16, 2014]. Available from: .
    1. O’Donoghue C, Eklund M, Ozanne EM, Esserman LJ. Aggregate cost of mammography screening in the United States: comparison of current practice and advocated guidelines. Ann Intern Med. 2014;160(3):145.
    1. Brodersen J, Jørgensen KJ, Gøtzsche PC. The benefits and harms of screening for cancer with a focus on breast screening. Pol Arch Med Wewn. 2010;120(3):89–94.
    1. Brodersen J, Siersma VD. Long-term psychosocial consequences of false-positive screening mammography. Ann Fam Med. 2013;11(2):106–115.
    1. Salz T, Richman AR, Brewer NT. Meta-analyses of the effect of false-positive mammograms on generic and specific psychosocial outcomes. Psychooncology. 2010;19(10):1026–1034.
    1. Bond M, Pavey T, Welch K, et al. Systematic review of the psychological consequences of false-positive screening mammograms. Health Technol Assess. 2013;17(13):1–170. v–vi.
    1. Harvey SC, Vegesna A, Mass S, Clarke J, Skoufalos A. Understanding patient options, utilization patterns, and burdens associated with breast cancer screening. J Womens Health (Larchmt) 2014;23(Suppl 1):S3–S9.
    1. Alcusky M, Philpotts L, Bonafede M, Clarke J, Skoufalos A. The patient burden of screening mammography recall. J Womens Health (Larchmt) 2014;23(Suppl 1):S11–S19.
    1. Chubak J, Boudreau DM, Fishman PA, Elmore JG. Cost of breast-related care in the year following false positive screening mammograms. Med Care. 2010;48(9):815–820.
    1. Philpotts L, Kalra V, Crenshaw J, Butler R. How tomosynthesis optimizes patient work up, throughput, and resource utilization; Abstract presented at the Radiological Society of North America Scientific Assembly and Annual Meeting; Chicago, IL, USA. December 1–6, 2013; [Accessed October 16, 2014]. Available from: .
    1. American Cancer Society . Cancer Prevention and Early Detection Facts and Figures 2013. Atlanta, GA, USA: American Cancer Society; 2013. [Accessed October 16, 2014]. Available from: .
    1. Cronin KA, Miglioretti DL, Krapcho M, et al. Bias associated with self-report of prior screening mammography. Cancer Epidemiol Biomarkers Prev. 2009;18(6):1699–1705.

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