Abstract：
BACKGROUND: Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan\'s National Health Insurance program.
METHODS: All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings.
RESULTS: The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2).
CONCLUSIONS: DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.
METHODS: All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings.
RESULTS: The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2).
CONCLUSIONS: DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.
摘要：
背景：乳房X线摄影（MG）已证明其在乳腺癌筛查计划中可有效降低死亡率和晚期乳腺癌发生率。值得注意的是,研究强调了数字化乳腺断层合成(DBT)的卓越诊断效能和成本效益.然而,验证DBT成本效益的证据范围仍然有限，促使更全面调查的必要条件。本研究旨在在台湾国民健康保险计划的框架内，严格评估DBT加MG（DBT-MG）与仅MG相比的成本效益。
方法：马尔可夫决策树模型的所有参数，包括事件概率，成本,和公用事业(质量调整寿命年，QALYs)，来自著名的文献，专家意见,官方记录。有10,000次迭代，一个2年的周期长度，30年的时间跨度，和2%的年折现率，分析确定了增量成本-效果比(ICER),以比较两种筛查方法的成本-效果.还进行了概率和单向敏感性分析，以证明研究结果的稳健性。
结果：与MG相比，DBT-MG的ICER为5971.5764美元/QALYs。在每个QALY的支付意愿（WTP）门槛为33,004美元（2021年台湾国内生产总值）时，超过98%的概率模拟赞成采用DBT-MG和MG。单向敏感性分析还表明，ICER在很大程度上依赖于召回率，活检率，和阳性预测值（PPV2）。
结论：DBT-MG显示出增强的诊断效能，潜在的召回成本下降。虽然显示出较高的活检率，DBT-MG有助于检测早期乳腺癌，降低召回率，并表现出明显的成本效益。
方法：马尔可夫决策树模型的所有参数，包括事件概率，成本,和公用事业(质量调整寿命年，QALYs)，来自著名的文献，专家意见,官方记录。有10,000次迭代，一个2年的周期长度，30年的时间跨度，和2%的年折现率，分析确定了增量成本-效果比(ICER),以比较两种筛查方法的成本-效果.还进行了概率和单向敏感性分析，以证明研究结果的稳健性。
结果：与MG相比，DBT-MG的ICER为5971.5764美元/QALYs。在每个QALY的支付意愿（WTP）门槛为33,004美元（2021年台湾国内生产总值）时，超过98%的概率模拟赞成采用DBT-MG和MG。单向敏感性分析还表明，ICER在很大程度上依赖于召回率，活检率，和阳性预测值（PPV2）。
结论：DBT-MG显示出增强的诊断效能，潜在的召回成本下降。虽然显示出较高的活检率，DBT-MG有助于检测早期乳腺癌，降低召回率，并表现出明显的成本效益。
