Spending on breast cancer screening has surged with the growth of digital breast tomosynthesis, according to a new research in JAMA Internal Medicine.
In 2015, this method accounted for just 13% of U.S. commercial claims billed for mammography but leapt to 70% by 2019, Yale School of Medicine experts detailed Monday. The adjusted average cost of a screening mammogram, either with or without DBT, rose 23% during the same period, up to nearly $296, while 2D mammography pricing stayed stable.
Lead Ilana Richman, MD, and colleagues said their findings fly in the face of previous claims that pricier DBT produces lower spending on downstream tests, due to lower recall rates.
“Higher screening costs are acceptable if they result in sufficient improvements in health or quality of life,” Richman, with Yale’s Department of Internal Medicine, et al. wrote Aug. 30. “However, a 2020 study suggested that although screening with DBT may be associated with small gains in quality of life, it is generally not cost-effective. Our findings highlight how shifting to DBT has been associated with substantial national expenditures, despite questions about value.”
The investigators arrived at their findings by analyzing insurance claims in the Blue Cross Blue Shield Axis database. Their sample included more than 8.4 million women who underwent almost 15.6 million screening mammograms between 2013 and 2019. While DBTs proliferated during the period, the proportion of patients who underwent subsequent tests and other imaging stayed stable, rising from 12% to 13% by 2019.
Mean cost of 2D mammo decreased by $1 during that span, down to about $239, and screening mammography costs (with or without DBT) climbed almost $56. DBT remained pricier than 2D mammography throughout the study period, hitting $316 in 2019. Subsequent screening expenditures and the cost of a screening episode also rose from 2013 to 2019, and total screening spending hit $5.2 billion that year, up from $3.9 billion (a 33% increase). Costs would have been about $1.1 billion less if women were imaged using only 2D mammography in 2019 compared to solely screening with DBT ($5.4 billion), the authors estimated.
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.