Cost-effectiveness of digital breast tomosynthesis versus digital mammography for breast cancer screening: a systematic literature review
Supakorn Chansaengpetch, Lisa Stirk, Nigel ArmstrongAbstract
Background
Digital breast tomosynthesis (DBT) is being rapidly adopted and has the potential to improve diagnostic performance compared with digital mammography (DM), the current standard for breast cancer screening. However, its cost-effectiveness remains uncertain, and a systematic synthesis of economic evidence is lacking. Therefore, this study aims to review existing cost-effectiveness analyses of DBT versus DM in average-risk women to inform policy decision-making and identify key considerations for future economic evaluations.
Methods
Seven databases (MEDLINE, Embase, KSR Evidence, Cochrane Library, NHSEED, CEA Registry, and RePEc IDEAS) were searched in June 2025. Eligible studies included cost-utility analysis and cost-effectiveness analysis of DBT compared with DM alone in women at average risk of breast cancer. Outcomes included costs and effectiveness, measured in quality-adjusted life years or life years gained. Study characteristics, modeling approaches, and cost-effectiveness results were extracted and narratively synthesized.
Results
A total of 10 studies published between 2015 and 2025 were included, 5 assessing DBT with DM and 5 assessing standalone DBT. Conclusions varied from cost-saving to not cost-effective. Studies including women aged 40–74 years and modeling biennial screening generally found DBT to be cost-effective. Evidence for standalone DBT was limited but suggested potential cost savings in some settings.
Conclusions
DBT may be a cost-effective intervention compared with DM for breast cancer screening. However, further robust economic evaluations, particularly of standalone DBT, are warranted to inform policy decision-making across diverse healthcare settings, particularly within Asian settings.