title: Cost-Effectiveness of Tomosynthesis in Annual Screening Mammography.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the cost-effectiveness of the addition of annual screening tomosynthesis to 2D digital mammography alone for women beginning at 40 years old and to determine differences for age decade subgroups.
  
  
  METHODS
  Decision-tree analysis comparing annual tomosynthesis versus 2D mammography alone from a federal payer perspective and lifetime horizon was created from published multiinstitutional data, published institutional data, literature values, and Medicare reimbursement rates. Cost-effectiveness was calculated through incremental cost-effectiveness ratios and net monetary benefit calculations. Sensitivity analyses were performed to determine the implication of different variables including changes in recall rate and disutility for false-positives.
  
  
  RESULTS
  Base-case analysis showed an incremental cost per quality-adjusted life year gained for tomosynthesis over 2D alone for all ages (≥ 40 years old) of $20,230, 40- to 49-year-old subgroup of $20,976, 50- to 59-year-old subgroup of $49,725, 60- to 69-year-old subgroup of $44,641, and ≥ 70-year-old subgroup of $82,500. Net monetary benefit per decade in the 40- to 49-year-old subgroup was $1,598, 50- to 59-year-old subgroup of $546, 60- to 69-year-old subgroup of $535, and ≥ 70-year-old subgroup of $501. Tomosynthesis was the better strategy in 63.2% of the iterations according to probabilistic sensitivity analysis.
  
  
  CONCLUSIONS
  Addition of annual screening tomosynthesis to 2D mammography beginning at the age of 40 years was cost-effective compared with 2D mammography alone in our analysis. Three times greater net monetary benefits were found in women 40-49 years old compared with those 50-59 years old.
authors.affiliation: 1 Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042.
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kalra
authors.affiliation: 1 Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wu
authors.affiliation: 1 Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Haas
authors.affiliation: 1 Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042.
authors.forename: Howard P
authors.initials: HP
authors.lastname: Forman
authors.affiliation: 1 Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042.
authors.forename: Liane E
authors.initials: LE
authors.lastname: Philpotts
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D003663:Decision Trees; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000191:economics; D008327:Mammography / Q000191:economics*; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000191:economics
keywords: cost-effectiveness; mammography; screening; tomosynthesis