Ultrasound-first strategy most cost-effective for recalled breast cancer screening patients
An ultrasound-first strategy appears most cost-effective for evaluating recalled breast cancer screening patients with noncalcified lesions, according to new research published Wednesday.
Digital breast tomosynthesis is increasingly being used for screening, with over 11,000 accredited units in the U.S. as of last year. However, previous research has demonstrated that ultrasound (rather than DBT) may be sufficient for assessing certain patients called back for additional imaging.
Experts at the University of Texas Southwestern Medical Center sought to better inform such decision-making, conducting a modeling study using data from their institution and information from previous studies. They found clear benefit for physicians who reached for ultrasound rather than DBT in these scenarios, according to new research published in the American Journal of Roentgenology.
“For diagnostic evaluation of DBT-recalled noncalcified lesions, a strategy of ultrasound first is cheaper and more effective compared to traditional evaluation with diagnostic mammography first,” lead author B. Bersu Ozcan, MD, with UT Southwestern’s Department of Radiology, and colleagues wrote July 31.
The analysis utilized probabilities and prevalence information from published single-institution data, along with estimates of diagnostic test performance derived from previously published studies, and Medicare-allowable reimbursement rates. They found that ultrasound-first evaluation of DBT-recalled noncalcified lesions was more cost-effective than a mammo-first strategy (with total costs of $17,672 vs. $18,323). Ultrasound also was more effective, logging 23.1309 quality-adjusted life years over the 40-year horizon compared to 23.1306 for DBT.
Ultrasound-first resulted in an incremental net monetary benefit of about $681 versus using diagnostic mammography first. In further simulations, ultrasound-first was the most cost-effective strategy in 93% of 10,000 iterations.
“In deterministic sensitivity analyses, the most important driver of cost-effectiveness was the lost utility from delayed diagnosis, followed by relative sensitivities of ultrasound and diagnostic mammography,” the authors reported. “Further large prospective multi-institutional studies with subgroup analysis considering lesion type would allow building more robust models,” they added later.
Read more, including potential study limitations, in AJR at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.