Cost-Effectiveness Analysis of Digital Breast Tomosynthesis Added to Synthetic Mammography in Breast Cancer Screening in Brazil

Henrique Lima Couto (), Ludmila Peres Gargano, Vilmar Marques Oliveira, Bertha Andrade Coelho, Eduardo Carvalho Pessoa, Augusto Tufi Hassan, Agnaldo Lopes Silva, Linei Augusta Brolini Delle Urban, Luciano Chala Fernandes, Nisha Sharma, Ritse Mann, Stuart A McIntosh and Fernando Zanghelini
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Henrique Lima Couto: Brazilian Society of Mastology, Rio de Janeiro
Ludmila Peres Gargano: Federal University of Minas Gerais
Vilmar Marques Oliveira: Santa Casa de São Paulo School of Medical Sciences
Bertha Andrade Coelho: Brazilian Society of Mastology, Rio de Janeiro
Eduardo Carvalho Pessoa: Brazilian Society of Mastology, Rio de Janeiro
Augusto Tufi Hassan: Brazilian Society of Mastology, Rio de Janeiro
Agnaldo Lopes Silva: Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro
Linei Augusta Brolini Delle Urban: Brazilian College of Radiology
Luciano Chala Fernandes: Brazilian College of Radiology
Nisha Sharma: Leeds Teaching Hospital NHS Trust
Ritse Mann: Radboud University Medical Center
Stuart A McIntosh: Queen’s University Belfast
Fernando Zanghelini: MAPESolutions

PharmacoEconomics - Open, 2024, vol. 8, issue 3, No 5, 403-416

Abstract: Abstract Background Literature meta-analysis results show that digital breast tomosynthesis (DBT) combined with synthesized two-dimensional (s2D) mammograms can reduce recalls and improve breast cancer detection. Uncertainty regarding the screening of patients with breast cancer presents a health economic challenge, both in terms of healthcare resource use and quality of life impact on patients. Objective This study aims to estimate the cost effectiveness of DBT + s2D versus digital mammography (DM) used in a biennial breast cancer screening setting of women aged 40–69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts in the Brazilian supplementary health system. Methods A cost-effectiveness analysis was performed on the basis of clinical data obtained from a systematic review with meta-analysis performed to evaluate the analytical validity and clinical utility of DBT + s2D compared with DM. The search was conducted in the PubMed, Cochrane Library and Embase databases, with the main descriptors of the technology, a comparator, and the clinical condition in question, on 9 June 2022. The hybrid economic model (decision tree plus Markov model) simulated costs and outcomes over a lifetime for women aged 40–69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts. We analyzed incremental cost-effectiveness ratio (ICER) to measure the incremental cost difference per quality-adjusted life year (QALY) of adding DBT + s2D to breast cancer screening. Results DBT + s2D incurred a cost saving of € 954.02 per patient, in the time horizon of 30 years, compared with DM, and gained 5.1989 QALYs, which would be considered a dominant intervention. These results were confirmed in sensitivity analyses. Conclusion Switching from DM to biennial DBT + s2D was cost effective. Furthermore, reductions in false-positive recall rates should also be considered in decision making.

Date: 2024
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DOI: 10.1007/s41669-023-00470-7

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