Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model.
OBJECTIVE
To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program.


METHODS
A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared.


RESULTS
Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term.


CONCLUSIONS
Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.
Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
Mercè
M
Comas
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Gipuzkoa Oeste Research Unit, Hospital Alto Deba, Arrasate, Spain.
Arantzazu
A
Arrospide
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Gipuzkoa Oeste Research Unit, Hospital Alto Deba, Arrasate, Spain.
Javier
J
Mar
Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
Maria
M
Sala
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Basic Medical Sciences Department, Biomedical Research Institute of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Spain.
Ester
E
Vilaprinyó
Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Cristina
C
Hernández
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Management Control Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Francesc
F
Cots
Radiology Department, Hospital del Mar, Barcelona, Spain.
Juan
J
Martínez
Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
Xavier
X
Castells
D000368:Aged; D000375:Aging; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics*; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D011336:Probability; D015397:Program Evaluation; D011856:Radiographic Image Enhancement / Q000379:methods; D012680:Sensitivity and Specificity; D013030:Spain