Assessing Health Care Use and Cost Consequences of a New Screening Modality

Abstract

Background Full-field digital mammography (FFDM) has largely replaced screen-film mammography (SFM) for breast cancer screening, but how this affects downstream breast-related use and costs is unknown. Objectives To compare breast-related healthcare use and costs among Medicare beneficiaries undergoing SFM versus FFDM from 1999 to 2005. Design Retrospective cohort study. Subjects Medicare-enrolled women ages 66 and older with mammograms in Breast Cancer Surveillance Consortium registries. Measures Subsequent follow-up with additional imaging or breast biopsy within 12 months was ascertained through Medicare claims. Associated mean costs were estimated by screening modality and year, adjusting for confounding factors and clustering within mammography facilities using Generalized Estimating Equations. Results Among 138,199 women, 332,324 SFM and 22,407 FFDM mammograms were analyzed. Approximately 6.5% of SFM and 9.0% of FFDM had positive findings. In 2001 subsequent imaging was higher among FFDM versus SFM (127.5 vs. 97.4 follow-up mammography claims per 1000 index mammograms) whereas subsequent biopsy was lower among FFDM versus SFM (19.2 vs. 24.9 per 1000 index mammograms) with differences decreasing over time. From 2001 to 2004, mammography subsequent to FFDM had higher mean costs than SFM ($82.60 vs. $64.31 in 2001). The only cost differences between SFM and FFDM for ultrasound or biopsy were in 2001. Conclusions Subsequent breast-related healthcare use differed early in FFDM introduction, but diminished over time with differences attributable to higher recall rates for additional imaging and lower rates of biopsy in those undergoing FFDM vs. SFM. Remaining cost differences are due to higher reimbursement rates for FFDM vs. SFM.

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

“…There is a large volume of studies that investigated the costeffectiveness of specific modalities of radiology, such as CT colonography versus conventional colonoscopy for colorectal screening, 146,147 full-field digital mammography versus screen film mammography, 148,149 and digitized radiological department versus traditional radiology, 150 although this latter is no longer an issue because PACS is widely accepted and implemented in radiology departments. We focus here on economic studies that investigated the benefits and costs of teleradiology versus traditional radiology, as shown in Table 3.…”

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

“…The analyses were based in a number of countries including the USA (n = 18 239,257,263,267,271,272,274,275,277,278,283,[289][290][291][292][293]295,298 ), the UK (n = 15 241,243,246,247,249,253,261,265,273,276,279,287,297,299,303 ), the Netherlands (n = 4 242,244,256,259 ), Hong Kong (n = 4 [304][305][306][307] ), Australia (n = 3 254,262,302 ), Italy (n = 3 245,251,252 ), Japan (n = 2 284,…”

Racial Differences in False-positive Mammogram Rates

“…Studies have documented a learning curve for digital mammography in which recall rates increased after implementation of digital mammography and decreased over time. (32, 33) The effect of the learning curve appears to have been magnified in black women since they were less likely to have comparison films available at the time of digital mammography evaluation. Our results with DMIST participants may reflect a transient racial difference in digital mammography accuracy during implementation of a new screening technology, but additional data tracking the false-positive rate over time after digital mammography implementation would be needed to test this hypothesis.…”