SAN ANTONIO – Although digital breast tomosynthesis (DBT), or 3-D mammography, costs more than a digital mammography (DM) screening, it actually may help rein in cancer screening costs, according to preliminary findings (PD7-05) presented by researchers from the Perelman School of Medicine at the University of Pennsylvania during the 2017 San Antonio Breast Cancer Symposium. The group analyzed 46,483 screening episodes – a single screening mammogram and all subsequent breast diagnosis related costs for the following year – in two hospitals within the University of Pennsylvania Health System in 2012 and 2013.
"Early detection is critical to saving lives and lowering costs," said senior author Emily F. Conant, MD, chief of Breast Imaging at Penn Medicine. "Fortunately, breast imaging is more precise than ever thanks to DBT. Despite its higher initial cost, DBT is increasingly being embraced by radiologists nationwide. If you look at expenses associated with breast diagnosis in the following year after initial screening, DBT is more cost effective in terms of health system or population level screening."
Previous studies modeling outcomes have demonstrated that DBT can be cost effective. In this study, the authors analyzed actual costs and patient outcomes within a single health system where both DM and DBT screening occurred. They excluded any episodes in which the patient had a prior breast cancer diagnosis or reached 90 years of age before the end of the follow-up period. DM represented 53 percent of the episodes and DBT represented 47 percent. Fifty three percent of women studied received DM and 47 percent received DBT.
They tested DBT and DM according to four outcomes – true positive (TP), true negative (TN), false positive (FP), and false negative (FN) rates – by comparing the Breast Imaging Reporting and Data System (BI-RADS) score (assigned at screening with data about subsequent cancer diagnosis).
DBT was a more effective screening method. Compared to DM episodes, DBT episodes had lower FP (8.6% vs. 10.8%) and higher TN (90.9% vs. 88.7%, p
Although it screened more effectively, DBT did cost more than DM. Overall, average episode costs were higher for DBT compared to DM ($378.02 vs. $286.62). This difference was driven by higher average screening costs ($215.94 vs. $155.76), which approximated the additional charge for DBT, as well as follow-up costs ($23.67 vs. $12.11). There was no significant difference in costs between DBT and DM episodes within the diagnosis or cancer treatment windows.
DM and DBT episodes had roughly the same average episode costs per woman screened for FP ($67.75 vs. $65.71), FN ($4.63 vs. $5.60) and TP ($85.80 vs. $65.15) outcomes despite the higher cost per individual DBT study. The higher costs for TN ($219.84 vs. $150.16) outcomes approximated the higher CMS charge for DBT.
The team's findings will be presented during a poster discussion on Friday December 8, at 7:00 a.m. CT in the Stars at Night Ballroom 1 & 2.
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In addition to Conant, the other co-authors on the study include Geraldine J. Liao, Henry A. Glick, Marie B. Synnestvedt, and Mitchell D. Schnall, all from Penn Medicine.
Funding for this study was provided by the National Institutes of Health (5U54CA163313-03).
Editor's note: Emily Conant is on the scientific advisory board of Hologic, Inc and received a grant from Hologic, Inc.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania(founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.
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