OBJECTIVES: Digital mammography is costlier than screen film mammography but presents benefits at the technological and logistic level. The aim of this study was to analyze the budget impact and the health benefits of the introduction of digital mammography in a population-based breast cancer screening program. METHODS: A discrete-event simulation model was implemented including the processes under a breast cancer screening program and the natural history of breast cancer. The screening events included: invitation (biennial) of the target population (women aged 50-69 years), participation, screening test, confirmatory tests after a positive mammography result, cancer diagnosis and treatment. Natural history of breast cancer included the following health states: no cancer, pre-clinical (non symptomatic) cancer, clinical (or symptomatic) cancer and death. Digital and analogical mammography had the same sensitivity, but different specificities were applied according to type of mammography and also initial or successive screening. Results were collected during a 20-year screening scenario.  RESULTS: A total of 90,575 women were screened under both techniques during the simulated 20 years. This population resulted in more than 262,500 screening mammograms. The recall rate was 5.9% under digital mammography and 6.4% under analogical mammography, while the numbers of confirmatory tests needed were 23,728 and 32,697, respectively. The cancer detection rate was 0.7% for both techniques. Digital mammography saved 1.909.167 euros in additional tests, while it was 1.026.807 euros more expensive in screening mammograms and presented similar costs of treatments. CONCLUSIONS: Results suggest that, although population-based breast cancer screening with digital mammography is costlier in terms of screening mammographies, it saves money in terms of additional tests needed. The health benefits are similar to those of conventional analogical mammography, but it reduces the number of additional tests needed, which represent a clear benefit to participating women.