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Couto HL, Gargano LP, de Oliveira VM, Coelho BA, Pessoa EC, Hassan AT, Silva AL, Urban LABD, Fernandes LC, Sharma N, Mann R, McIntosh SA, Zanghelini F. Cost-Effectiveness Analysis of Digital Breast Tomosynthesis Added to Synthetic Mammography in Breast Cancer Screening in Brazil. PHARMACOECONOMICS - OPEN 2024; 8:403-416. [PMID: 38233699 PMCID: PMC11058155 DOI: 10.1007/s41669-023-00470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Literature meta-analysis results show that digital breast tomosynthesis (DBT) combined with synthesized two-dimensional (s2D) mammograms can reduce recalls and improve breast cancer detection. Uncertainty regarding the screening of patients with breast cancer presents a health economic challenge, both in terms of healthcare resource use and quality of life impact on patients. OBJECTIVE This study aims to estimate the cost effectiveness of DBT + s2D versus digital mammography (DM) used in a biennial breast cancer screening setting of women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts in the Brazilian supplementary health system. METHODS A cost-effectiveness analysis was performed on the basis of clinical data obtained from a systematic review with meta-analysis performed to evaluate the analytical validity and clinical utility of DBT + s2D compared with DM. The search was conducted in the PubMed, Cochrane Library and Embase databases, with the main descriptors of the technology, a comparator, and the clinical condition in question, on 9 June 2022. The hybrid economic model (decision tree plus Markov model) simulated costs and outcomes over a lifetime for women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts. We analyzed incremental cost-effectiveness ratio (ICER) to measure the incremental cost difference per quality-adjusted life year (QALY) of adding DBT + s2D to breast cancer screening. RESULTS DBT + s2D incurred a cost saving of € 954.02 per patient, in the time horizon of 30 years, compared with DM, and gained 5.1989 QALYs, which would be considered a dominant intervention. These results were confirmed in sensitivity analyses. CONCLUSION Switching from DM to biennial DBT + s2D was cost effective. Furthermore, reductions in false-positive recall rates should also be considered in decision making.
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Affiliation(s)
- Henrique Lima Couto
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil.
- Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil.
- Redimama-Redimasto, Belo Horizonte, Minas Gerais, Brazil.
- Brazilian Society of Mastology, Av. João Pinheiro, 161-Centro, Belo Horizonte, MG, 30130-180, Brazil.
| | - Ludmila Peres Gargano
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- MAPESolutions, São Paulo, São Paulo, Brazil
| | - Vilmar Marques de Oliveira
- Brazilian Society of Mastology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Bertha Andrade Coelho
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- UNIFIMOC University Center, Montes Claros, Minas Gerais, Brazil
| | - Eduardo Carvalho Pessoa
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | - Augusto Tufi Hassan
- Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Oncoclinicas-CAM, Salvador, BA, Brazil
| | - Agnaldo Lopes Silva
- Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Nisha Sharma
- Breast Screening Unit, Seacroft Hospital, Leeds Teaching Hospital NHS Trust, York Road, Leeds, West Yorkshire, LS146UH, UK
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Fernando Zanghelini
- MAPESolutions, São Paulo, São Paulo, Brazil
- Health Economics Consultant, Norwich Medical School, University of East Anglia, Norwich, UK
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