Cost-effectiveness of digital mammography breast cancer screening.
BACKGROUND
The DMIST (Digital Mammography Imaging Screening Trial) reported improved breast cancer detection with digital mammography compared with film mammography in selected population subgroups, but it did not assess the economic value of digital relative to film mammography screening.


OBJECTIVE
To evaluate the cost-effectiveness of digital mammography screening for breast cancer.


METHODS
Validated, discrete-event simulation model.


METHODS
Data from DMIST and publicly available U.S. data.


METHODS
U.S. women age 40 years or older.


METHODS
Lifetime.


CONCLUSIONS
Societal and Medicare.


METHODS
All-film mammography screening; all-digital mammography screening; and targeted digital mammography screening, which is age-targeted digital mammography (for women <50 years of age) and age- and density-targeted digital mammography (for women <50 years of age or women > or =50 years of age with dense breasts).


METHODS
Cost per quality-adjusted life-year (QALY) gained.


RESULTS
All-digital mammography screening cost $331,000 (95% CI, $268,000 to $403,000) per QALY gained relative to all-film mammography screening but was more costly and less effective than targeted digital mammography screening. Targeted digital mammography screening resulted in more screen-detected cases of cancer and fewer deaths from cancer than either all-film or all-digital mammography screening, with cost-effectiveness estimates ranging from $26,500 (CI, $21,000 to $33,000) per QALY gained for age-targeted digital mammography to $84,500 (CI, $75,000 to $93,000) per QALY gained for age- and density-targeted digital mammography. In the Medicare population, the cost-effectiveness of density-targeted digital mammography screening varied from a base-case estimate of $97,000 (CI, $77,000 to $131,000) to $257,000 per QALY gained (CI, $91,000 to $536,000) in the alternative-case analyses, in which the sensitivity of film mammography was increased and the sensitivity of digital mammography in women with nondense breasts was decreased.


RESULTS
Results were sensitive to the cost of digital mammography and to the prevalence of dense breasts.


CONCLUSIONS
Results were dependent on model assumptions and DMIST findings.


CONCLUSIONS
Relative to film mammography, screening for breast cancer by using all-digital mammography is not cost-effective. Age-targeted screening with digital mammography seems cost-effective, whereas density-targeted screening strategies are more costly and of uncertain value, particularly among women age 65 years or older.
Tosteson
Anna N A
AN
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. anna.tosteson@dartmouth.edu
Stout
Natasha K
NK
Fryback
Dennis G
DG
Acharyya
Suddhasatta
S
Herman
Benjamin A
BA
Hannah
Lucy G
LG
Pisano
Etta D
ED
D000328:Adult; D000368:Aged; D001940:Breast / Q000033:anatomy & histology; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods*; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D014481:United States