Simulation Modeling to Understand the Cost-Effectiveness and Outcomes of Digital Breast Tomosynthesis

BCSC investigators, in collaboration with the CISNET and PROSPR groups, use similation modeling to understand the cost-effectiveness and long-term outcomes for women screened with digital breast tomosythesis.

Posted by Kathryn Lowry, MD at 10:55 AM on Sep 26, 2019


In an article published online in JNCI on September 9th, 2019, “Long-term outcomes and cost-effectiveness of digital breast tomosynthesis for breast cancer screening in the United States,” Dr. Lowry and colleagues from the BCSC, Cancer Intervention and Surveillance Modeling Network (CISNET), and Population-Based Screening through Personalized Regimens (PROSPR) consortium used three microsimulation models to estimate the impact of digital breast tomosynthesis (DBT) on screening outcomes, breast cancer mortality, and cost-effectiveness of breast cancer screening. 

The three models simulated complete transition from conventional digital mammography (DM) to DBT and compared projected long-term outcomes for women ages 40 and older to those when DM is used.  Based on these projections, the transition to DBT reduced the number of false positive screening exams by 24-28%.  There was a small improvement in quality-of-life (approximately 2-3 additional quality-adjusted life years per 1,000 women), and slight improvement in breast cancer mortality (0-0.2 fewer deaths due to breast cancer per 1,000 women).  However, the costs of DBT were high relative to the clinical benefits ($195,026-$270,135 per quality-adjusted life year).  When the team simulated alternative scenarios of DBT price and performance, DBT was more cost-effective when the price of DBT screening was reduced by approximately half, or when DBT sensitivity improved by 4%.  These findings suggest that although there are benefits of DBT (particularly for false positive exams), DBT screening for the U.S. population is relatively expensive based on current costs and performance.

Full Text Citation & Link: Lowry KP, Trentham-Dietz A, Schechter CB, Alagoz O, Barlow WE, Burnside ES, Conant EF, Hampton JM, Huang H, Kerlikowske K, Lee SJ, Miglioretti DL, Sprague BL, Tosteson ANA, Yaffe M, Stout NK.   Long-term outcomes and cost-effectiveness of breast cancer screening with digital breast tomosynthesis in the United States.  J Natl Cancer Inst 2019. doi: https://doi.org/10.1093/jnci/djz184 [Link to Article]

These findings have been covered by the following media outlets:

Posted by: Kathryn Lowry, MD