title: Value Analysis of Digital Breast Tomosynthesis for Breast Cancer Screening in a US Medicaid Population.
abstract: OBJECTIVE
  Better understanding regarding the clinical-economic value of digital breast tomosynthesis (DBT) for breast cancer screening for Medicaid enrollees is needed to help inform sound, value-based decision making. The objective of this study was to conduct a clinical-economic value analysis of DBT for breast cancer screening among women enrolled in Medicaid to assess the potential clinical benefits, associated expenditures, and net budget impact of DBT.
  
  
  METHODS
  Two annual screening mammography scenarios were evaluated with an economic model: (1) full-field digital mammography and (2) combined full-field digital mammography and DBT. The model focused on two main drivers of DBT value: (1) capacity for DBT to reduce the number of women recalled for additional follow-up imaging and diagnostic services and (2) capacity of DBT to facilitate earlier diagnosis of cancer at earlier stages, when treatment costs are lower.
  
  
  RESULTS
  Model analysis results showed that the use of DBT as a mammographic screening modality by Medicaid enrollees potentially reduces the need for follow-up diagnostic services and improves the detection of invasive cancers, allowing earlier, less costly treatment. With the modest incremental reimbursement of $37 for DBT expected for a typical Medicaid claim, annual cost savings from DBT predicted by the model amounts to $8.14 per patient, potentially translating into more than $12,000 savings per year for an average-sized Medicaid plan and as much as $207,000 savings per year for a typical state Medicaid program.
  
  
  CONCLUSIONS
  Wider adoption of DBT presents an opportunity to deliver value-based care to Medicaid programs and to help address disparities and barriers to accessing preventive care by some of the nation's most vulnerable citizens.
authors.affiliation: Truven Health Analytics, an IBM Company, Cambridge, Massachusetts. Electronic address: jeffrey.d.miller@truvenhealth.com.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Miller
authors.affiliation: Truven Health Analytics, an IBM Company, Cambridge, Massachusetts.
authors.forename: Machaon M
authors.initials: MM
authors.lastname: Bonafede
authors.affiliation: Department of Radiology and Vermont Cancer Center, Robert Larner College of Medicine at the University of Vermont, Burlington, Vermont.
authors.forename: Sally D
authors.initials: SD
authors.lastname: Herschorn
authors.affiliation: Hologic, Inc., Marlborough, Massachusetts.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Pohlman
authors.affiliation: Hologic, Inc., Marlborough, Massachusetts.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Troeger
authors.affiliation: Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Fajardo
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008327:Mammography / Q000191:economics*; D008403:Mass Screening / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D014481:United States
keywords: Breast cancer screening; Medicaid; cost analysis; digital breast tomosynthesis; mammography