Tomosynthesis costs less than digital mammography when diagnosis-related costs are taken into consideration, according to a new study presented on Friday at the San Antonio Breast Cancer Symposium.

“This study further supports that screening with tomosynthesis is associated with better screening outcomes and is cost-effective at the population level,” Dr. Emily Conant, senior author of the study and chief of Breast Imaging at Penn Medicine, told HCB News.

Conant and her team evaluated actual costs and patient outcomes within a single health system where both tomosynthesis and digital mammography screening occurred. The study included a total of 46,483 screening episodes that took place between 2012 and 2013 at two hospitals within the University of Pennsylvania Health System.

If a patient had a prior breast cancer diagnosis or reached 90 years of age before the end of the follow-up period, those episodes were excluded. Fifty-three percent of the women received digital mammography exams and 47 percent received tomosynthesis.

The researchers identified the exams as true positive, true negative, false positive, and false negative by comparing the BI-RADS score. They found that tomosynthesis was a more effective screening method because it had a lower false positive rate and higher true negative rate.

The upfront cost of tomosynthesis was higher than for digital mammography — $378.02 versus $286.62 — but there was no significant difference in costs within the diagnosis or cancer treatment windows.

“Digital breast tomosynthesis is considered the ‘new, better mammogram,’ but there remain gaps in insurance coverage for the imaging modality,” said Conant. “While there have been models evaluating the cost-effectiveness of tomosynthesis screening, there have been no analyses looking at actual patient outcomes and actual costs.”

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