Adding automated breast ultrasound to mammography in women with increased breast density or at an elevated risk of breast cancer is a cost-effective screening strategy.

objectivesAutomated breast ultrasound imaging (ABUS) results in a reduction in breast cancer stage at diagnosis beyond that seen with mammographic screening in women with increased breast density or who are at a high risk of breast cancer. It is unknown if the addition of ABUS to mammography or ABUS imaging alone, in this population, is a cost-effective screening strategy.

methodsA discrete event simulation (Monte Carlo) model was developed to assess the costs of screening, diagnostic evaluation, biopsy, and breast cancer treatment. The number of quality-adjusted life years gained through each screening method is assessed using previously published quality of life measures. Incremental cost-effectiveness ratios for screening with the combination of mammographic and ABUS imaging, and for ABUS imaging alone are calculated as compared to standard mammographic imaging.

resultsCombined screening with both mammographic and ABUS imaging results in an incremental cost-effectiveness ratio of $7,071 ($6,332-$7,809) when compared to traditional mammographic imaging (p < 0.05). ABUS screening alone results in an incremental cost-effectiveness ratio of $3,559 ($- 965-$8,082) when compared to mammographic imaging (p < 0.05). ABUS screening alone is more likely to be cost-effective for a willingness-to-pay of less than $7,100.

conclusionsThe addition of ABUS to mammographic imaging is a cost-effective screening strategy in women with increased breast density or who are at a high risk of developing breast cancer. ABUS imaging alone is also a cost-effective strategy in this population, particularly in resource-poor areas.