COST-UTILITY ANALYSIS OF DIGITAL BREAST TOMOSYNTHESIS FOR BREAST CANCER SCREENING IN KOREAN WOMEN
Author(s)
yunjeong kwon, MPH1, Tae Jin Lee, PhD2.
1Seoul National University, seoul, Korea, Republic of, 2Professor, Seoul National University, Seoul, Korea, Republic of.
1Seoul National University, seoul, Korea, Republic of, 2Professor, Seoul National University, Seoul, Korea, Republic of.
OBJECTIVES: This study aimed to evaluate the cost-utility of digital breast tomosynthesis (DBT) versus digital mammography (DM) for breast cancer screening among asymptomatic Korean women aged ≥40 years within the Korean National Cancer Screening Program (NCSP), considering the high prevalence of dense breasts and the limited diagnostic performance of DM.
METHODS: A cost-utility analysis was conducted from the healthcare payer perspective comparing DBT, DM, and no screening. A hybrid decision tree-Markov model was developed using a lifetime horizon and the biennial screening interval of the NCSP. The decision tree simulated BI-RADS-based screening outcomes and follow-up procedures, including breast ultrasound and biopsy, while the Markov model captured cancer-free, stage-specific breast cancer, treatment, and death states. Health outcomes were measured in quality-adjusted life years (QALYs). Screening, diagnostic, and treatment costs were estimated using the National Health Insurance fee schedule and K-CURE registry-linked National Health Insurance claims data. One-way and probabilistic sensitivity analyses were performed to address parameter uncertainty.
RESULTS: Compared with DM, DBT resulted in higher lifetime costs (KRW 1,571,906 vs. KRW 1,431,944) and greater health benefits (19.4332 vs. 19.3995 QALYs), yielding an incremental cost of KRW 139,962 and 0.0337 additional QALYs. The incremental cost-effectiveness ratio (ICER) was KRW 4,148,331/QALY, well below the willingness-to-pay threshold of KRW 51,789,000/QALY. Although no screening produced slightly higher QALYs because screening-related disutility was not incurred, it was not cost-effective compared with DBT (ICER: KRW 503,841,227/QALY). DBT remained cost-effective in age-specific scenario analyses (≥50 and ≥60 years). Sensitivity analyses identified DM sensitivity and DBT screening cost as the primary drivers of the ICER. In probabilistic sensitivity analysis, DBT had the highest probability of being cost-effective (64.2%) at the willingness-to-pay threshold.
CONCLUSIONS: DBT is likely to be a cost-effective alternative to DM for breast cancer screening in Korea and may improve screening performance among women with dense breasts within the NCSP.
METHODS: A cost-utility analysis was conducted from the healthcare payer perspective comparing DBT, DM, and no screening. A hybrid decision tree-Markov model was developed using a lifetime horizon and the biennial screening interval of the NCSP. The decision tree simulated BI-RADS-based screening outcomes and follow-up procedures, including breast ultrasound and biopsy, while the Markov model captured cancer-free, stage-specific breast cancer, treatment, and death states. Health outcomes were measured in quality-adjusted life years (QALYs). Screening, diagnostic, and treatment costs were estimated using the National Health Insurance fee schedule and K-CURE registry-linked National Health Insurance claims data. One-way and probabilistic sensitivity analyses were performed to address parameter uncertainty.
RESULTS: Compared with DM, DBT resulted in higher lifetime costs (KRW 1,571,906 vs. KRW 1,431,944) and greater health benefits (19.4332 vs. 19.3995 QALYs), yielding an incremental cost of KRW 139,962 and 0.0337 additional QALYs. The incremental cost-effectiveness ratio (ICER) was KRW 4,148,331/QALY, well below the willingness-to-pay threshold of KRW 51,789,000/QALY. Although no screening produced slightly higher QALYs because screening-related disutility was not incurred, it was not cost-effective compared with DBT (ICER: KRW 503,841,227/QALY). DBT remained cost-effective in age-specific scenario analyses (≥50 and ≥60 years). Sensitivity analyses identified DM sensitivity and DBT screening cost as the primary drivers of the ICER. In probabilistic sensitivity analysis, DBT had the highest probability of being cost-effective (64.2%) at the willingness-to-pay threshold.
CONCLUSIONS: DBT is likely to be a cost-effective alternative to DM for breast cancer screening in Korea and may improve screening performance among women with dense breasts within the NCSP.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE704
Topic
Economic Evaluation, Medical Technologies
Disease
Oncology