Original Title: Evaluación comparativa de la mamografía digital 2D frente a la 3D en términos de resultados de identificación temprana y revaloración y sus implicaciones económicas en condiciones de práctica habitual dentro de un programa de cribado poblacional de cáncer de mama de alta participación: estudio Convince-RWD.

Authors' objectives: To undertake economic analysis comparing the costs and effectiveness of DBT vs DM for breast cancer screening in the framework of the Basque Breast Cancer Early Detection Programme.

Authors' results and conclusions: A total of 37,229 baseline mammograms were analysed for DM and 34,479 for DBT. For a cohort of 50,000 women screened, we found that the number of cancer cases detected with DM and DBT were 216 and 255, respectively (18% more with DBT), and the total costs of DM and BDT were €1,925,207.72 and €3,132,723.53, respectively (63 % more with DBT). The incremental cost of €1,207,516.25 and incremental effectiveness of 39 cases of cancer detected yield an ICER of €30,961.96, this figure corresponding to the increase in costs related to detecting one more case of cancer with BDT than with DM during the screening process. During the screening process, there were a total of 2,325 recalls associated with DBT and 2,355 with DM, with associated costs of €3,132,723.53 and €1,925,207.27, respectively. In this case, the incremental cost was €1,207,516.25 and the incremental effectiveness was -30, implying an ICER of €40,250.54 per recall avoided by using BDT vs DM. The univariate sensitivity analysis indicated that the variable with the greatest effect on the outcomes in the economic evaluation was the cost of the two-view mammogram with tomosynthesis used for the population screening, the ICER decreasing by 46.35 % when the cost of the test was €46. The bivariate sensitivity analysis indicated that reducing the price of the two-view screening mammogram with tomosynthesis and that of unilateral two-view mammogram with tomosynthesis by 20 % at the same time led to a 48.03 % reduction in the ICER when the cost of the tests was €46 and €64, respectively. CONCLUSIONS This analysis conducted for this report indicates that, in the context of the Basque Breast Cancer Early Detection Programme and for one round of screening in routine practice, and with the only difference being the dates when the screening round took place and avoiding the potential influence of other variables on the final outcome, such as the health professionals, organisation, or devices, the use of DBT for baseline screening rather than DM leads to an increase in the number of cancer cases detected and a reduction in the number of recalls with higher associated costs. Reductions in the total costs associated with DBT may mean that BDT-based breast cancer screening becomes cost-effective or cost-equivalent to DM-based screening.

Authors' methods: Economic and cost-effectiveness analysis was performed based on baseline mammograms obtained as part of this screening programme, specifically in the Detection and Evaluation Unit of Onkologikoa, the Oncology Institute of Donostia, between 1 June 2017 and 31 May 2018 for DBT and between 1 June 2011 and 31 May 2012 for DM. The economic analysis was carried out for the general population of women between 50 and 69 years of age, regardless of their breast density, the only exclusion criterion being having a previous diagnosis of breast cancer. The analysis was carried out from the perspective of the funding body of the Basque Health System and for a temporal horizon corresponding to what was considered one round of screening under the aforementioned programme. An analytical decision model, a decision tree, was developed to evaluate the costs and consequences of using the techniques of interest, DBT and DM. The probabilities necessary to complete the model were obtained from the screening programme’s registry (Onkologikoa’s Detection and Evaluation Unit). Effectiveness was measured as the number of women with cancer detected by the screening (main outcome measure) and the number of mammography examinations requiring recall for further assessment (secondary outcome measure). The costs included were the direct healthcare costs associated with the screening process: baseline radiological examinations using DBT and DM; recall, involving additional radiological examinations with DBT, DM and ultrasound; and intermediate radiological check-ups with DBT and DM. The cost and effectiveness results provided by the model were used to calculate the incremental effectiveness, incremental cost and incremental cost-effectiveness ratio (ICER) that indicates the incremental cost of the use of DBT vs DM per additional case of breast cancer detected. Deterministic sensitivity analysis was performed (both univariate and bivariate) to assess the uncertainty associated with the different variables on which the analysis was based.

Project Status: Completed

Year Published: 2022

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/OSTEBA_Informe_EvaluacionD-22-01.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>