title: Value analysis of digital breast tomosynthesis for breast cancer screening in a commercially-insured US population.
abstract: OBJECTIVE
  The objective of this study was to conduct a value analysis of digital breast tomosynthesis (DBT) for breast cancer screening among women enrolled in US commercial health insurance plans to assess the potential budget impact associated with the clinical benefits of DBT.
  
  
  METHODS
  An economic model was developed to estimate the system-wide financial impact of DBT as a breast cancer screening modality within a hypothetical US managed care plan with one million members. Two scenarios were considered for women in the health plan who undergo annual screening mammography, ie, full field digital mammography (FFDM) and combined FFDM + DBT. The model focused on two main drivers of DBT value, ie, the capacity for DBT to reduce the number of women recalled for additional follow-up imaging and diagnostic services and the capacity of DBT to facilitate earlier diagnosis of cancer at less invasive stages where treatment costs are lower. Model inputs were derived from published sources and from analyses of the Truven Health MarketScan(®) Research Databases (2010-2012). Comparative clinical and economic outcomes were simulated for one year following screening and compared on an incremental basis.
  
  
  RESULTS
  Base-case analysis results show that 4,523 women in the hypothetical million member health plan who are screened using DBT avoid the use of follow-up services. The overall benefit of DBT was calculated at $78.53 per woman screened. Adjusting for a hypothetical $50 incremental cost of the DBT examination, this translates to $28.53 savings per woman screened, or $0.20 savings per member per month across the plan population and an overall cost savings to the plan of $2.4 million per year.
  
  
  CONCLUSIONS
  The results of this study demonstrate clinical and economic favorability of DBT for breast cancer screening among commercially-insured US women. Wider adoption of DBT mammography presents an opportunity to deliver value-based care in the US health care system.
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA.
authors.forename: Machaon M
authors.initials: MM
authors.lastname: Bonafede
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kalra
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Miller
authors.affiliation: Department of Radiology, University of Iowa College of Medicine, Iowa City, IA, USA.
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Fajardo
keywords: breast cancer screening; cost analysis; digital breast tomosynthesis; economic model; mammography; value analysis