Abstract
ObjectiveTo assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program.MethodsA discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared.ResultsStatistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term.ConclusionsSwitching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.
Highlights
In Spain, all resident women aged 50–69 are actively invited to participate in the population-based breast cancer screening program by written letter every 2 years
Over the 20 simulated years, 151,960 women were dynamically incorporated into the target population, making a total of 251,960 women invited to the program and resulting in more than 731,400 screening mammograms, of which 15.3% corresponding to initial screening (Table 2)
Fewer additional tests were required with digital mammography (Table 2)
Summary
In Spain, all resident women aged 50–69 are actively invited to participate in the population-based breast cancer screening program by written letter every 2 years. Previous studies have emphasized the benefits of the technical features of digital mammography: the image is visualized in a computer window instead of a hard copy, which precludes film processing, storage, copying and retrieval. These benefits revert at the logistic level within a screening program: mammograms are visualized, stored and retrieved more and allow radiologists to manipulate the image (such as zooms or changes of brightness and contrast) without additional exposure of the woman to radiation and attendance to the hospital. The cost-effectiveness of this switch in population-based screening programs, which involve millions of women and millions of tests, is controversial and, to our knowledge, no budget impact analysis has been performed to date
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