title: Cost-benefit analysis of biopsy methods for suspicious mammographic lesions; discussion 994-5.
abstract: OBJECTIVE
  Stereotactic core biopsy (SCB) is more cost-effective than needle-localized biopsy (NLB) for evaluation and treatment of mammographic lesions.
  
  
  METHODS
  A computer-generated mathematical model was developed based on clinical outcome modeling to estimate costs accrued during evaluation and treatment of suspicious mammographic lesions. Total costs were determined for evaluation and subsequent treatment of cancer when either SCB or NLB was used as the initial biopsy method. Cost was estimated by the cumulative work relative value units accrued. The risk of malignancy based on the Breast Imaging Reporting Data System (BIRADS) score and mammographic suspicion of ductal carcinoma in situ were varied to simulate common clinical scenarios.
  
  
  METHODS
  Total cost accumulated during evaluation and subsequent surgical therapy (if required).
  
  
  RESULTS
  Evaluation of BIRADS 5 lesions (highly suggestive, risk of malignancy = 90%) resulted in equivalent relative value units for both techniques (SCB, 15.54; NLB, 15.47). Evaluation of lesions highly suspicious for ductal carcinoma in situ yielded similar total treatment relative value units (SCB, 11.49; NLB, 10.17). Only for evaluation of BIRADS 4 lesions (suspicious abnormality, risk of malignancy = 34%) was SCB more cost-effective than NLB (SCB, 7.65 vs. NLB, 15.66).
  
  
  CONCLUSIONS
  No difference in cost-benefit was found when lesions highly suggestive of malignancy (BIRADS 5) or those suspicious for ductal carcinoma in situ were evaluated initially with SCB vs. NLB, thereby disproving the hypothesis. Only for intermediate-risk lesions (BIRADS 4) did initial evaluation with SCB yield a greater cost savings than with NLB.
authors.affiliation: Division of Surgical Oncology, Suite 3010, UC Davis Cancer Center, 4501 X St, Sacramento, CA 95817, USA. richard.bold@ucdmc.ucdavis.edu
authors.forename: B N
authors.initials: BN
authors.lastname: Fahy
authors.forename: R J
authors.initials: RJ
authors.lastname: Bold
authors.forename: P D
authors.initials: PD
authors.lastname: Schneider
authors.forename: V
authors.initials: V
authors.lastname: Khatri
authors.forename: J E
authors.initials: JE
authors.lastname: Goodnight
mesh_terms: D001706:Biopsy / Q000191:economics* / Q000379:methods; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics; D008327:Mammography; D008408:Mastectomy / Q000191:economics; D015412:Mastectomy, Segmental / Q000191:economics; D008962:Models, Theoretical; D015895:Relative Value Scales; D013238:Stereotaxic Techniques