Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio Emilia, Modena, Italy.
Radiol Med. 2024 Sep;129(9):1288-1302. doi: 10.1007/s11547-024-01850-7. Epub 2024 Aug 20.
This study quantifies the impact on budget and cost per health benefit of implementing digital breast tomosynthesis (DBT) in place of digital mammography (DM) for breast cancer screening among asymptomatic women in Italy.
A budget impact analysis and a cost consequence analysis were conducted using parameters from the MAITA project and literature. The study considered four scenarios for DBT implementation, i.e., DBT for all women, DBT for women aged 45-49 years, DBT based on breast density (BI-RADS C + D or D only), and compared these to the current DM screening. Healthcare provider's perspective was adopted, including screening, diagnosis, and cancer treatment costs.
Introducing DBT for all women would increase overall screening costs by 20%. Targeting DBT to women aged 45-49 years or with dense breasts would result in smaller cost increases (3.2% for age-based and 1.4-10.7% for density-based scenarios). The cost per avoided interval cancer was significantly higher when DBT was applied to all women compared to targeted approaches. The cost per gained early-detected cancer slightly increases in targeted approaches, while the assumptions on the clinical significance and overdiagnosis of cancers detected by DBT and not by DM have a strong impact.
Implementing DBT as a primary breast cancer test in screening programs in Italy would lead to a substantial increase in costs. Tailoring DBT use to women aged 45-49 or with dense breasts could enhance the feasibility and sustainability of the intervention. Further research is needed to clarify the impact of DBT on overdiagnosis and the long-term outcomes.
本研究旨在量化在意大利对无症状女性进行乳腺癌筛查时，用数字乳腺断层合成术（DBT）替代数字乳腺摄影术（DM）对预算和每健康效益成本的影响。
采用 MAITA 项目和文献中的参数进行预算影响分析和成本后果分析。研究考虑了 DBT 实施的四种方案，即所有女性进行 DBT、45-49 岁女性进行 DBT、基于乳腺密度（BI-RADS C+D 或仅 D）的 DBT，并将其与当前的 DM 筛查进行比较。采用医疗保健提供者的视角，包括筛查、诊断和癌症治疗成本。
在所有女性中引入 DBT 将增加整体筛查成本 20%。针对 45-49 岁的女性或乳腺致密的女性进行 DBT，成本增加幅度较小（年龄为基础的方案增加 3.2%，基于密度的方案增加 1.4-10.7%）。与靶向方法相比，当所有女性都应用 DBT 时，避免间隔期癌症的每成本显著更高。在靶向方法中，每获得早期检测癌症的成本略有增加，而对 DBT 检测而不是 DM 检测的癌症的临床意义和过度诊断的假设具有强烈影响。
在意大利的筛查项目中，将 DBT 作为乳腺癌的主要筛查方法将导致成本大幅增加。根据女性年龄 45-49 岁或乳腺致密程度，有针对性地使用 DBT，可以提高干预的可行性和可持续性。需要进一步研究来阐明 DBT 对过度诊断和长期结果的影响。
