Vivek Bihari Kalra MD, Presenter: Nothing to Disclose

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

Liane Elizabeth Philpotts MD, Abstract Co-Author: Consultant, Hologic, Inc.

To determine the cost-effectiveness of tomosynthesis in screening mammography compared to 2D mammography based on relative and absolute direct costs resulting from unnecessary diagnostic workups from recalled patients between modalities. 

The diagnostic workups resulting from screening recalls performed with tomosynthesis and 2D mammography were tabulated from a one year period at a single institution in a HIPAA compliant, IRB-waived study. Unnecessary diagnostic workups were defined as those that subsequently returned to screening or had biopsies with non-malignant pathology. All imaging was performed on Selenia Dimensions units (Hologic, Bedford, MA). Patients were evaluated with tomosynthesis or 2D without preferential assignment. The direct costs of basic diagnostic mammographic imaging, advanced diagnostic imaging, biopsy procedure costs, and pathology interpretation costs were assessed using 2013 regional facility Medicare payment values. 

During the one-year period, 13,174 patients underwent screening mammography, of which 6,116 had tomosynthesis and 7,058 had 2D mammograms. 516 (8.4%) of tomosynthesis patients were recalled and 826 (11.7%) of 2D screening mammography patients were recalled (p<0.0001). There was no significant difference in patient characteristics between the two groups. The relative and absolute costs of the unnecessary diagnostic workups, as defined as those in patients who subsequently returned to screening or had non-malignant pathology, were assessed using 2013 regional facility Medicare payment values. Screening tomosynthesis resulted in a relative cost savings of 17.1%. Loosely correlated to the difference in the recall rate, the cost savings were amplified in younger populations (7.7X in those < 40yo) and those with dense breasts (3.9X in extremely dense breasts). Older patients demonstrated increased diagnostic workup costs in the tomosynthesis groups.  

Screening tomosynthesis decreased the overall costs of unnecessary diagnostic workups by 17.1%. Much larger cost savings were seen in younger patients and those with dense breasts, with a decrease of 46.6% in extremely dense breasts and 50.9% in patients under 40.

Patients with dense breasts and younger patients demonstrate greater cost-effectiveness in screening tomosynthesis, which had an overall relative cost savings of 17.1% compared to 2D mammography.

Kalra, V, Haas, B, Philpotts, L, Cost-Effectiveness of Tomosynthesis in Screening Mammography: Analysis by Breast Density and Patient Age  .  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044485.html