3D mammogram use boosted by removing out-of-pocket fee

3D mammogram use boosted by removing out-of-pocket fee | Image Credit: © Valerii Apetroaiei - © Valerii Apetroaiei - stock.adobe.com.

Digital breast tomosynthesis (DBT) access is improved by removing a $45 out-of-pocket fee, according to a recent study published in the Journal of the American College of Radiology.¹

Financial barriers limit access to advanced screening

According to investigators, the availability of life-saving treatment is often lessened by even small financial barriers. This includes DBT, which is more effective at cancer detection than other methods and reduces false positive results. Removing patient cost-share may improve health care equity and allow more patients to utilize this treatment.

"These findings demonstrate that even modest out-of-pocket costs can create meaningful barriers to accessing advanced screening technology," said Nina M. Capiro, MD, lead author and diagnostic radiologist at UCLA Health.

Comparing DBT and digital mammography

The retrospective study was conducted to determine the impact of removing the out-of-pocket fee for DBT on DBT use vs 2D-digital mammography (DM).² The study institution initially required a $45 out-of-pocket fee for patients to receive DBT, which was eliminated in January 2021.

DBT was offered at scheduling, imaging appointment check-in, and prior to image acquisition. Women scheduled to undergo screening mammogram between March 1, 2018, and August 31, 2022, were included in the analysis.

Electronic medical records were assessed for patient demographic and insurance data, including race and ethnicity, primary insurance at examination, age, preferred language, and social vulnerability index (SVI).

Rates of screening mammography using DBT were reported as the primary outcome. Pre-intervention DBT was defined as undergoing a DBT screening before the fee removal, while post-intervention DBT was defined as undergoing a DBT screening after the fee removal. These rates were compared to those of DM screening during the same periods.

Patient demographics and utilization trends

There were 13,284 patients included in the final analysis, aged a mean 61.5 years. Of patients, 39.8% were non-Hispanic White, 13.9% Asian, 6.6% Black, and 11.7% Hispanic. English was the preferred language of 96.4%, and 63.8% had commercial primary insurance.

DBT was reported in 10,729 patients, with 1428 transitioning from pre-intervention DM to post-intervention DBT and 733 receiving both pre- and post-intervention DM. Asian, Black, and Hispanic patients were more likely to receive pre-intervention and post-intervention DM, alongside non-English speaking patients.

Increased DBT utilization

An overall DBT utilization rate of 83.7% was reported pre-intervention vs 91.5% post-intervention. These rates were 84.7% and 90.6%, respectively, in White patients, 75.9% and 86.8%, respectively, in Asian patients, 75.7% and 87.8%, respectively, in Black patients, and 74.7% and 86.8%, respectively, in Hispanic patients.

Compared to White patients, Asian, Black, and Hispanic patients had more significant increases in DBT use by 5%, 6.2%, and 6.2%, respectively, from the pre-intervention to post-intervention period. Compared to English speaking patients, the rise in DBT use among non-English speaking patients was 7.1%.

Post-intervention DBT was compared in patients with DBT vs DM use pre-intervention through a multivariable analysis. Language other than English, the most vulnerable SVI, and younger age were the variables most significantly associated with transitioning from DM to DBT, with odds ratios of 1.97, 1.83, and 0.847, respectively.

Remaining disparities

These results indicated increased utilization and reduced disparities when removing the out-of-pocket cost for DBT. However, investigators recommended additional strategies to further ensure equitable DBT access.

“This research shows how policy changes can have measurable impacts on health equity, but it also reminds us that eliminating financial barriers alone may not be sufficient to address all access challenges,” said Capiro.¹

References

1. Removing out-of-pocket fee improves access to 3D mammography. University of California Los Angeles Health Sciences. June 27, 2025. Accessed July 2, 2025. https://www.eurekalert.org/news-releases/1089133.
2. Capiro N, Khadka P, Sayre J, Sadigh G, Hoyt A. Effect of fee removal on the usage of digital breast tomosynthesis to minimize healthcare disparities. Journal of the American College of Radiology. 2025. doi:10.1016/j.jacr.2025.06.022