title: Comparing the cost-effectiveness of the triple test score to traditional methods for evaluating palpable breast masses.
abstract: BACKGROUND
  Physical examination, mammography, ultrasonography, and fine needle aspiration are traditionally used to guide further management of palpable breast masses, often leading to open biopsy of benign masses. The triple test score (TTS) integrates physical examination, mammography, and fine needle aspiration in the initial evaluation, limiting open biopsy.
  
  
  OBJECTIVE
  To compare cost-effectiveness of TTS and traditional methods.
  
  
  METHODS
  The primary measure of clinical effectiveness, frequency of missed malignancy, was determined for each strategy using probabilities and outcomes from a systematic literature review. Costs were calculated using the Medicare resource-based relative-value scale. A decision-analytic model compared costs of initial work-up, costs per mass evaluated, and costs per malignancy diagnosed. Sensitivity analyses assessed the influence of variations in model assumptions.
  
  
  RESULTS
  In the base case, neither strategy led to undiagnosed breast cancer. However, open biopsy was required in 13% of benign masses using TTS versus 88% using the traditional strategy. The cost of the initial work-up using traditional management was less than TTS (377 US dollars vs. 627 US dollars), but cost per mass evaluated and cost per malignancy diagnosed (1793 US dollars vs. 925 US dollars and 5670 US dollars vs. 2925 US dollars) favored TTS, due to substantially reduced open biopsy.In sensitivity analyses, TTS cost varied most with changes in cost of initial evaluation, whereas the traditional strategy cost varied most with changes in open biopsy cost.
  
  
  CONCLUSIONS
  The TTS provides equivalent diagnostic effectiveness but substantially lower cost than traditional management. Cost savings are based on decreased open biopsy, a major contributor to the cost of traditional evaluation in this model.
authors.affiliation: University of Washington, Seattle, Washington, USA. morrisa@u.washington.edu
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Morris
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: Rodney F
authors.initials: RF
authors.lastname: Pommier
authors.forename: John T
authors.initials: JT
authors.lastname: Vetto
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008327:Mammography; D010173:Palpation; D014481:United States