Annual DBT screening could yield significant savings for payors

 - Laurie Fajardo, MD

The use of digital breast tomosynthesis (DBT) as a breast screening modality could account for $550 billion dollars in breast cancer healthcare savings annually, according to a study published Jan. 12 in the Journal of ClinicoEconomics and Outcomes Research.

In their paper, the authors pointed out that studies have shown that the use of DBT significantly reduces recall rates while detecting more invasive cancers. “We haven’t seen a breast imaging technology performing at this level come along in a very long time,” said study co-author Laurie L. Fajardo, MD, of  the University of Iowa College of Medicine. “The fact that the technology costs more and needs to be reimbursed at a higher rate than conventional mammography, means that some analysts and payors need to have a better understanding about the clinical and economic value of tomosynthesis.” 

For purposes of the study, Fajardo and colleagues from Truven Health Analytics and Yale University, developed an economic model based on insurance claims data (from two Truven Analytics research databases) between 2010 and 2012, and published clinical data comparing healthcare spending on women who underwent DBT along with traditional digital ma mmography versus women who only underwent traditional digital mammography.

The authors derived the screening costs from the claims database analysis and estimated the cost of digital mammography at $192.50 ($164.51 from the mammography portion of the exam, and $27.99 from the associated computer-aided detection portion). At the time the authors developed their model, a CPT code for tomosynthesis had been announced, but no reimbursement rate established.  The authors estimated—based on what they anticipated the rate would be—that the total screening cost for digital mammography and DBT would be $242.50, $50 more than the current reimbursement rate for digital mammography.

According to the authors, the financial impact of using DBT along with digital mammography for annual screening in a managed care plan with 1 million members would result in an overall cost savings to the plan of $2.4 million per year. That translates to a savings of $28.53 per screened patient, or $0.20 per member per month across the plan’s population.

Extrapolating further, the authors estimated that “using a conservative estimate that one half of the approximately 39 million mammograms performed annually in the U.S. are for screening (excluding Veterans Administration facilities)” then per patient net cost savings could account for over $550 million in annual U.S. breast cancer healthcare savings.

So, what drives these cost savings? “Finding more cancers at an earlier stage results in less costly treatments,” Fajardo pointed out. “But the real cost savings is in the avoidance of recalls.”

In the study, Fajardo and her colleagues estimated that average cost of follow-up services due to abnormal screening results is $1,205.29. They also referred to a study by Vivek Kalra, M.D., of Yale University, and colleagues presented at the 2013 meeting of the Radiological Society of North America that found that the use of DBT screening reduced the overall costs of unnecessary diagnostic workups by 17.1%.

“With approximately one in seven women receiving additional diagnostic imaging following digital screening mammography at an average cost of over $1,200, and with the costs of breast cancer ranging with increasing stage from $35,000 to $224,000, wider adoption of DBT mammography presents a significant opportunity to deliver value-based care in the US health care system,” the authors concluded.

As for the potential economic impact on individual women, “I don’t think payors are going to be able to ignore this much longer,” Fajardo said, pointing out that the increasing prevalence of high-deductible insurance plans could be deterring women from requesting tomosynthesis. “”As people get into these high deductible plans we don’t want women who are relatively healthy have to pay for that tomosynthesis exam because [they haven’t met the deductible].”

The authors wrote that future research in this area should “evaluate the potential impact of DBT from the perspective of patients and/or other types of payors.” For example, Fajardo said, she and her colleagues are currently looking at data regarding Medicaid patients and those individuals who are uninsured or underinsured.