OBJECTIVES: The use of digital breast tomosynthesis (DBT) and breast ultrasound (US) for breast cancer screening has increased in recent years. Our objective was to describe utilization trends and health plan costs of DBT and US compared to traditional full-field digital mammography alone (FFDM).

METHODS: The IBM Watson Health MarketScan Commercial Database was used to identify women aged 40-64 years undergoing screening mammography in 2005-2017. Screening rates were reported per calendar year among women with continuous enrolment for that entire calendar year. The prevalence and average cost was described for each scenario (FFDM alone, FFDM+DBT, and FFDM+US), as well as the rate of diagnostic mammography performed within 180 days. Costs were calculated for 2017 results.

RESULTS: On average, approximately 5.2M women met the inclusion criteria per year. The average annual prevalence of screening mammography increased from 38.9% in 2005 to 45.0% in 2017 with an average annual rate of 43.9%. The prevalence FFDM+US on the same day increased from 0.7% in 2005 to 4.5% in 2017 while FFDM+DBT increased from 10.4% in 2015 to 37.2% in 2017. Diagnostic mammography rates following a screening exam decreased slightly from 9.1% in 2005 to 8.0% in 2017. The prevalence of US on or up to six months after the screening date increased from 6.3% in 2005 to 11.0% in 2017. Based on 2017 claims data, the average cost of each regimen was claims–based cost for each screening regimen was $252.86 for FFDM, $333.64 for FFDM+DBT and $509.44 for FFDM+US.

CONCLUSIONS: Despite increases in prevalence, FFDM+US remains less common than FFDM+DBT. FFDM+US has higher initial screening costs than FFDM+DBT than either FFDM+DBT or FFDM alone. Additional research should be conducted to understand which factors contribute to this difference and their impact on overall healthcare costs.