title: A study on the cost effectiveness of sestamibi scintimammography for screening women with dense breasts for breast cancer.
abstract: The potential impact of Sestamibi scintimammography (SSMM) on the cost effective management of women with dense breasts is not known. This study addresses this issue quantitatively by examining the impact of SSMM based screening strategies on the approximately 3,000,000 women over 40 with very dense breasts (DY patterns) without palpable masses and who have had one or more prior mammograms, who undergo routine screening each year. Quantitative decision tree sensitivity analysis was used to compare the conventional mammography (MM) strategy (strategy A), which does not subject patients with negative mammograms to any further examination until their next screening, with two decision strategies for screening with SSMM; SSMM after a negative mammogram (strategy B) or SSMM as the only screening test for women already identified as having dense breasts by a previous mammogram (strategy C). Cost effectiveness was measured by calculating the incremental cost effectiveness ratio (ICER) of strategies B and C, which is the cost of achieving an additional year of life in the screening population by choosing a SSMM based decision strategy rather than the conventional strategy. Strategies B and C reduced the number of false negative diagnoses by 62% and 8%, respectively. The ICER was $632,000 and $3.18M per life year for strategy B and C, respectively. To be cost effective, the pre-test probability of cancer in the study population must be greater than 3% for strategy B or the cost of SSMM must be less than $50 for strategy C. These results show the ICER of an SSMM based breast cancer screening strategy in the management of patients with dense breasts is not currently within the range (approximately $50,000 per year life saved) of other commonly performed medical interventions that are considered cost effective.
authors.affiliation: Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Allen
authors.forename: P
authors.initials: P
authors.lastname: Hendi
authors.forename: L
authors.initials: L
authors.lastname: Bassett
authors.forename: M E
authors.initials: ME
authors.lastname: Phelps
authors.forename: S S
authors.initials: SS
authors.lastname: Gambhir
mesh_terms: D000328:Adult; D001940:Breast / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000191:economics / Q000379:methods; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000493:pharmacokinetics
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi