Cost-effectiveness of digital mammography compared to film mammography in screening of breast cancer: a systematic review

Background: Mammography as the best method of diagnosing breast cancer in its early stages has been accepted in many countries. Digital mammography is in development and is used in breast cancer screening in countries such as the United States, however, cost-effectiveness of digital mammography screening (DMS) compared to film mammography screening (FMS) is debatable. This study is designed to systematically review the available evidence in this regard. Methods: This study is designed as a systematic review using PRISMA guidelines. The search was conducted on October 2019 on the PubMed, Web of Science core collection, Embase, Scopus, Cochrane library and ProQuest databases. All full economic evaluation studies (cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA)) that assessed DMS compared to FMS are included. The quality of final articles were evaluated by CHEERS checklist and data was collected using a data extraction form. Finally, the data was analyzed by a meta-synthesis method. Results: Five studies were included. Three of them were conducted in the U.S., one in the Australia, and one the Brazil. Studies show that despite the slight difference in the effectiveness of DMS, its costs increased more. Three studies concluded that age-targeted DMS and FMS might be cost-effective and two concluded biennial DMS might be cost-effective digital strategy, however one study concluded that biennial FMS is still cost-effective. Conclusion: There is currently little evidence on the cost-effectiveness of DMS over FMS and more evidence is needed, especially in developing countries. While the cost-effectiveness of DMS has not been fully confirmed, manufacturers are developing digital mammography; on the other hand, film mammography is obsoleting. Therefore, the move towards digital mammography, especially in developing countries, should be gradual and targeted.