Vivek Bihari Kalra MD, Presenter: Nothing to Disclose

Brian Haas MD, Abstract Co-Author: Nothing to Disclose

Howard Paul Forman MD, Abstract Co-Author: Nothing to Disclose

Liane Elizabeth Philpotts MD, Abstract Co-Author: Nothing to Disclose

To determine the cost effectiveness of mammographic screening using combined Digital Breast Tomosynthesis (DBT) and Full-Field Digital Mammography (FFDM) vs. FFDM alone based on direct costs resulting from differences in the recall rate.

Screening recall rates for combined DBT and standard FFDM screening studies were calculated at a single institution over a five month period. Studies were interpreted by a total of 7 board-certified radiologists, with 4-23 years of experience, all with tomosynthesis training. All DBT images were acquired using a single unit (Dimensions, Hologic, Bedford, MA) and all FFDM studies were performed on Selenia units (Hologic). Recall rates and number of diagnostic studies (unilateral mammograms, bilateral mammograms, and ultrasound studies) resulting directly from the recall were calculated. The direct costs of these studies were assessed using regional Medicare reimbursements. Downstream direct costs, indirect costs, and intangible costs were excluded. Screening effectiveness was determined based on calculated cancer detection rates for both groups.

In 5780 patients, screening mammograms were performed using combined DBT in 1602 patients and FFDM alone in 4178 patients. Combined DBT had an overall recall rate of 7.0%, while FFDM was 10.9% (p < 0.0001). Decreased recall rate resulted in statistically significant decreased number of immediate diagnostic studies [unilateral mammogram - 5.8% vs. 9.6% (p = 0.0007), bilateral mammogram - 0.1% vs. 1.0% (p < 0.0001), ultrasound - 5.5% vs. 7.7% (p = 0.0052). Using regional Medicare reimbursement values, the decrease resulted in a direct cost savings of $10,185 per 1,000 women screened. Combined DBT had a cancer detection rate of 5.6 per 1,000 while FFDM alone had a rate of 3.4 per 1,000 (p = 0.24).

Combined DBT had a direct cost savings of $10,185 per 1,000 women screened resulting from decreased callback rates. Given that there also appears to be a trend for improved cancer detection rate, combined DBT appears to be preferable to FFDM alone for screening mammography.

Decreased callback rates from combined DBT and FFDM compared to FFDM alone results in a direct costs savings of $10,185 per 1,000 women screened.

Kalra, V, Haas, B, Forman, H, Philpotts, L, Cost-Effectiveness of Digital Breast Tomosynthesis.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043617.html