Mammogram costs rise with digital breast tomosynthesis, study shows
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Breast cancer screening costs have risen considerably since 2013 due to the primary adoption of digital breast tomosynthesis over two-dimensional mammography, according to a research letter published in JAMA Internal Medicine.
“Higher screening costs are acceptable if they result in sufficient improvements in health or quality of life,” Ilana B. Richman, MD, MHS, an assistant professor in the department of internal medicine at Yale School of Medicine, and colleagues wrote. “However, a 2020 study suggested that although screening with DBT may be associated with small gains in quality of life, it is generally not cost effective.”
Richman and colleagues conducted an observational cohort study using Blue Cross Blue Shield Axis deidentified insurance claims. The cohort consisted of 8,432,037 women aged 40 to 64 years who underwent breast cancer screening using DBT or 2D mammography. A total of 15,669,701 screenings were included from January 1, 2013, to June 30, 2019. The researchers calculated the mean cost of initial screening tests, subsequent testing, screening episodes and national episodes in 6-month intervals.
The proportion of DBT mammograms that were billed increased from 13% in 2015 to 70% in 2019, according to the researchers. The adjusted mean cost of a breast cancer screening regardless of method increased from $239.80 (95% CI, $239.7-$239.9) in 2013 to $295.60 (95% CI, $296.4-$295.7) in 2019. The cost of a 2D mammogram remained consistent at $239.80 (95% CI, $239.7-$239.9) in 2013 and $238.80 (95% CI, $238.6-$239) in 2019. However, a DBT mammogram was consistently more expensive during the study period, increasing from $280.70 (95% CI, $280.3-$281.1) in 2015 to $315.60 (95% CI, 315.3-315.8) in 2019.
The proportion of women who received additional testing remained stable at 12% in 2013 and 13% in 2019. The costs of additional testing rose from $75.30 (95% CI, $74.5-$76.1) in 2013 to $99.30 (95% CI, $98.4-$100.3) in 2019. Also, Richman and colleagues found that the cost of screening episodes increased by 25%, from $316.40 (95% CI, $315.6-$317.2) in 2013 to $396.50 (95% CI, $395.5-$397.4) in 2019.
The total annual U.S. screening costs for the study population increased from roughly $3.9 billion in 2013 to $5.2 billion in 2019. Based on 2019 national estimations, if DBT was used for all screenings, the total cost would amount to $5.4 billion per year compared with $4.2 billion for screening with 2D mammography, Richman and colleagues wrote.
The researchers noted limitations to the study, including its observational design. They also noted that women who are screened with DBT may have a higher risk for breast cancer and higher follow-up costs.
“DBT may be more cost-effective among women who are at higher risk for breast cancer, such as older women with dense breasts,” Richman told Healio Primary Care. “However, we do not recommend using DBT or 2D mammography based on individual risk at this time, and a variety of factors, including what options are available locally and a woman’s preference, all play a role in screening choices.”