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For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below \u20ac20,000 per life year gain (LYG).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8\u201310.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7\u201318.7% when DBT sensitivity was at least 80% for scenario 2. At \u20ac96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At \u20ac80 per DBT, these values decreased to 80% and 90%, respectively.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Key Points<\/jats:title>\n<jats:p><jats:italic>\u2022 DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of \u20ac96.<\/jats:italic><\/jats:p>\n<jats:p><jats:italic>\u2022 DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of \u20ac80.<\/jats:italic><\/jats:p>\n<jats:p><jats:italic>\u2022 Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.<\/jats:italic><\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00330-020-06812-x","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T16:04:07Z","timestamp":1588867447000},"page":"5437-5445","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program"],"prefix":"10.1007","volume":"30","author":[{"given":"Jing","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan-Anh","family":"Phi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel J. 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