OBJECTIVES: About 43% of women ages 40 to 74 years are classified as having dense breasts. Digital breast tomosynthesis (DBT) and breast ultrasound (US) are increasingly used adjunctively with traditional full-field digital mammography (FFDM) for screening women with dense breasts. The objective was to develop an exploratory economic model to compare costs of dense breast screening with FFDM+DBT vs. FFDM+US, and also to evaluate costs of additional, follow-on examinations (“recall”) for the two screening modalities.

METHODS: An economic model was developed to perform the analyses. Screening and recall cost data for women aged 40-64 years were derived from the Truven Health MarketScan® Commercial Claims and Encounters Database RESULTS: In the base-case analysis, total costs (screening plus recall) for a woman with dense breasts screened via FFDM+DBT were $391.30 compared with $837.40 for FFDM+US. Adjunct DBT screening conferred savings of $446.10. About 68.5% ($289.23) of the savings was attributable to reduced recall utilization and substantially fewer (-49%) high-expense biopsies conducted on recalled FFDM+DBT patients. Results were robust over a wide range of sensitivity analyses and always cost favorable for FFDM+DBT.

CONCLUSIONS: Costs are an important driver for screening choices for women with dense breasts. Results of this study show strong financial favorability for FFDM+DBT over FFDM+US. These exploratory analyses will inform future comprehensive cost-effectiveness models.