title: Decision analysis for the cost effectiveness of sestamibi scintimammography in minimizing unnecessary biopsies.
abstract: BACKGROUND
  The purpose of this study was to assess if breast cancer screening using sestamibi scintimammography (SSMM) in conjunction with mammography (MM) is cost effective in avoiding biopsies in healthy patients.
  
  
  METHODS
  Quantitative decision tree sensitivity analysis was used to compare the conventional MM alone strategy (strategy A) with two decision strategies for screening with SSMM; SSMM after an indeterminate mammogram (strategy B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per patient and the average life expectancy per patient for baseline values as well as over a range of values for all of the variables of each strategy.
  
  
  RESULTS
  Based on Medicare reimbursement values, strategies B and C showed a cost savings of $9 and $20 per patient respectively as compared to strategy A. This translates into respective savings of $189 and $420 million per year assuming 21 million females undergo screening each year. Strategies B and C did however have a loss of mean life expectancy of 0.000178 and 0.000222 years respectively as compared to strategy A due to interval progression of breast cancer in a small number of women. Strategies B and C significantly lowered the number of biopsies performed on healthy patients in the screening population by 750,063 and 1,557,915 biopsies respectively as compared to strategy A.
  
  
  CONCLUSIONS
  These results quantitatively verify the potential utility of using SSMM in avoiding unnecessary biopsies.
authors.affiliation: Crump Institute for Biological Imaging, UCLA School of Medicine, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Allen
authors.forename: P
authors.initials: P
authors.lastname: Hendi
authors.forename: J
authors.initials: J
authors.lastname: Schwimmer
authors.forename: L
authors.initials: L
authors.lastname: Bassett
authors.forename: S S
authors.initials: SS
authors.lastname: Gambhir
mesh_terms: D001706:Biopsy / Q000191:economics*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008017:Life Expectancy; D008327:Mammography / Q000191:economics; D008403:Mass Screening / Q000191:economics*; D006278:Medicare / Q000191:economics; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000191:economics; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000191:economics; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi