title: Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis.
abstract: BACKGROUND
  Breast cancer in the U.S. - estimated at 232,670 incident cases in 2014 - has the highest aggregate economic burden of care relative to other female cancers. Yet, the amount of cost attributed to diagnostic/preoperative work up has not been characterized. We examined the costs of imaging and biopsy among women enrolled in Medicare who did and did not receive diagnostic/preoperative Magnetic Resonance Imaging (MRI).
  
  
  METHODS
  Using Surveillance, Epidemiology and End Results (SEER)- Medicare data, we compared the per capita costs (PCC) based on amount paid, between diagnosis date and primary surgical treatment for a breast cancer diagnosis (2005-2009) with and without diagnostic/preoperative MRI. We compared the groups with and without MRI using multivariable models, adjusting for woman and tumor characteristics.
  
  
  RESULTS
  Of the 53,653 women in the cohort, within the diagnostic/preoperative window, 20 % (N = 10,776) received diagnostic/preoperative MRI. Total unadjusted median costs were almost double for women with MRI vs. without ($2,251 vs. $1,152). Adjusted costs were higher among women receiving MRI, with significant differences in total costs ($1,065), imaging costs ($928), and biopsies costs ($138).
  
  
  CONCLUSIONS
  Costs of diagnostic/preoperative workups among women with MRI are higher than those without. Using these cost estimates in comparative effectiveness models should be considered when assessing the benefits and harms of diagnostic/preoperative MRI.
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. Tracy.L.Onega@dartmouth.edu.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Tracy.L.Onega@dartmouth.edu.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Tracy.L.Onega@dartmouth.edu.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Anna.N.A.Tosteson@dartmouth.edu.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Anna.N.A.Tosteson@dartmouth.edu.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. Julie.Weiss@dartmouth.edu.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Julie.Weiss@dartmouth.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: Weiss
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. Jennifer.A.Alford-Teaster@dartmouth.edu.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Jennifer.A.Alford-Teaster@dartmouth.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alford-Teaster
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA. rhubb@mail.med.upenn.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.affiliation: Department of Radiology, University of North Carolina, Chapel Hill, NC, USA. louise_henderson@med.unc.edu.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.affiliation: Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. Karla.Kerlikowske@ucsf.edu.|Department of Veterans Affairs, General Internal Medicine Section, University of California, San Francisco, CA, USA. Karla.Kerlikowske@ucsf.edu.
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. Martha.e.goodrich@dartmouth.edu.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Martha.e.goodrich@dartmouth.edu.
authors.forename: Martha E
authors.initials: ME
authors.lastname: Goodrich
authors.affiliation: Department of Surgery, Moffit Cancer Center, Tampa, FL, USA. cristina.odonoghue@gmail.com.
authors.forename: Cristina
authors.initials: C
authors.lastname: O'Donoghue
authors.affiliation: Group Health Research Institute, Seattle, WA, USA. wernli.k@ghc.org.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. wdemartini@uwhealth.org.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: DeMartini
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis, MN, USA. virni001@umn.edu.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008408:Mastectomy / Q000191:economics*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics / Q000379:methods; D018426:SEER Program; D014481:United States / Q000453:epidemiology