While clinical research continues on the pros and cons of film-screen versus full-field digital mammography, there's one area in which FFDM clearly surpasses film-screen: cost. Mammographers at the M.D. Anderson Cancer Center have logged nearly two years worth of time with FFDM. Their experience has been positive thus far; it has also been an expensive one.
Dr. Peter Dempsey, a professor of radiology in the breast imaging section at M.D. Anderson Cancer Center in Houston, shared some numbers with attendees at the 2001 Breast Imaging Conference in Monterey, CA . M.D. Anderson has worked with the Senographe 2000D (GE Medical Systems, Waukesha, WI) for year and a half, Dempsey said.
"What have we learned at our institution thus far? One of the clear benefits ... has been that FFDM is phenomenal for reading dense breasts. The equalization algorithm is showing us areas that were not previously well penetrated. We know we’ve been able to decrease the number of recalls," he said. FFDM's future advantages will include elimination of processing chemicals, the dark room, and the film library.
All of these benefits come at a price. At M.D. Anderson, the initial capital outlay for the unit was $450,000, Dempsey said, $370,000 more than the purchase price of a film-based machine. The current cost of running the equipment over a five-year period is $135,000 a year, compared to $24,000 for film-based mammography. But maintenance is where much of the money is doled out, Dempsey explained.
"The major [financial] difference between the two is maintenance, which a lot of people don’t understand. The current maintenance cost on FFDM at our institution is $45,000 per year. That’s a pretty hefty price tag, considering that you paid $450,000 for the privilege of getting into the game," he added.
In terms of examination costs, a screening exam with FFDM comes in at $219, while a unilateral diagnostic exam is $253 and a bilateral exam is $272. On the other hand, one traditional mammography exam is billed at $160 for screening, $176 for a unilateral diagnostic test, and $213 for a bilateral exam.
"One of the things that you must do with patients is address these additional costs, which may not be borne by [insurance]. It is very important," Dempsey stressed. "We make a big point of discussing this with our patients, that if they have a digital mammogram, there are these chargeable fees that the insurance may not cover."
However, the center does not charge for the use of computer-aided detection (CAD) because permanent records of those results are not kept, Dempsey said. For some hospitals, this may be too much of a burden, especially if the CAD system is not built into the FFDM unit, as is the case at M.D. Anderson. The CAD system cost $189,000 and included workstations and continuous-load digitizers, Dempsey said.
As with any new technology, the cost should come down as FFDM becomes more readily available, Dempsey said. In addition to the GE unit, Fischer Imaging of Denver received Food and Drug Administration clearance for its SenoScan full-field digital mammography in September. Eastman Kodak Health Imaging of Rochester, NY, and Hologic of Bedford, MA, are working on bringing their FFDM units to market.
"[FFDM] is a huge decision for many people," Dempsey said at the close of his talk. "Two things you want to ask yourself before you lay out the money: ‘Is [this unit] going to be obsolete in a year or two?’ and ‘Will the company that sold it to me assure me that upgrades will be available?’ We are just beginning to go down this road."
By Shalmali PalAuntMinnie.com staff writer
October 22, 2001
Related Reading
Fischer joins short list of FDA-approved digital mammography vendors, September 26, 2001
Hologic files PMA for Lorad digital mammography system, May 4, 2001
Speedier exam time gives digital mammography an edge over analog, May 4, 2001
Full-field digital mammography holds its own against screen-film mammography, March 4, 2001
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