OBJECTIVES: Women with high breast density have a higher risk of breast cancer and a lower likelihood of detecting a lesion with standard mammography screening. Digital breast tomosynthesis is a three-dimensional imaging modality that offers superior diagnostic performance compared with two-dimensional digital mammography in women with high breast density. The study objective was to evaluate the cost-effectiveness of digital breast tomosynthesis in mammography screening in women with high breast density from Czech payers’ perspective.

METHODS: Mammography screening and following cancer treatment was modelled using semi-Markov model for a cohort of women 45 years over a lifetime. The model consisted of four health states: healthy (no malignant lesion present), undiagnosed malignant neoplasm (false negative screening result), after treatment state, and death. The analysis was performed from the Czech payer's perspective. The current course of mammographic screening with two-dimensional mammography and other complementary examinations was chosen as a comparator. The screening cost data entering the model were quantified based on retrospective data collection at the mammography centre. Other costs and outcome data was sourced from published sources. All future costs and benefits were discounted by 3% annually. Cost-effectiveness was defined as below CZK 1,200,000/QALY (quality-adjusted life years) gained.

RESULTS: The total costs and benefits of the digital breast tomosynthesis are CZK 34,248 and 17.78 QALY and those of two-dimensional mammography were CZK 32,648 and 17.76 QALY. These equated to ICER of CZK 74,945/QALY.

CONCLUSIONS: Digital breast tomosynthesis is a cost-effective primary modality for preventive mammography screening for women with high breast density from a Czech payer’s perspective.