Digital Breast Tomosynthesis: Cost-Effectiveness of Using Private and Medicare Insurance in Community-Based Health Care Facilities.
OBJECTIVE
The purpose of this study was to determine whether digital breast tomosynthesis (DBT) is a cost-effective alternative to full-field digital mammography (FFDM) for both Medicare and privately insured patients undergoing screening mammography.


METHODS
A retrospective data analysis was performed between July 15, 2013, and July 14, 2014, with data on women presenting for screening mammography that included any additional radiologic workup (n = 6319). Patients chose to undergo DBT or FFDM on the basis of personal preference, physician suggestion, and cost difference. The summation of findings over the 1-year period were used to calculate recall rates, cancer detection rates, and billing costs for a regional private insurer and Medicare.


RESULTS
Data from the 6319 patients who participated were divided: 3655 patients underwent DBT, and 2664 underwent FFDM during the year of screening. Private insurance billing cost $2.9 million, and Medicare cost $1.2 million for screening, follow-up imaging, and radiologic procedures. Per-person costs were approximately $40 higher for the DBT group using both forms of insurance. However, cost per cancer detected was lower in the DBT group for both private and governmental insurance, leading to potentially $3.7 million and $899,000 saved per 100 cancers found. After standardization of the difference in cancer detection rates between the two groups, DBT was a cost-equivalent alternative to FFDM for private insurance billing but was a cost-inefficient alternative with respect to Medicare costs.


CONCLUSIONS
In a community-based setting, DBT is a cost-equivalent or potentially cost-effective alternative to FFDM and has the capacity for improving cancer detection and recall rates.
1 Northeast Ohio Medical University, 4209 St Rt 44, PO Box 95, Rootstown, OH 44272.
Sara A
SA
Hunter
2 Department of Radiology, Aultman Hospital, Canton, OH.
Colleen
C
Morris
2 Department of Radiology, Aultman Hospital, Canton, OH.
Karl
K
Nelson
3 Clinical Radiologists, Springfield, IL.
Brandon J
BJ
Snyder
2 Department of Radiology, Aultman Hospital, Canton, OH.
Thomas B
TB
Poulton
D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008327:Mammography / Q000191:economics*; D006278:Medicare / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
breast cancer; cost-effectiveness; digital breast tomosynthesis; screening mammography