Performance Goals for an Adjunct Diagnostic Test to Reduce Unnecessary Biopsies After Screening Mammography: Analysis of Costs, Benefits, and Consequences.
OBJECTIVE
Because benign biopsies resulting from false-positive mammographic findings are a known harm of breast cancer screening, physicians and test manufacturers are searching for ways to reduce their frequency. The aim of this study was to estimate potential costs and consequences associated with using an adjunct diagnostic test for triaging women with suspicious mammographic findings before biopsy.


METHODS
A decision model was developed to compare the use of an adjunct test before biopsy to the current standard of care for suspicious mammographic findings. The decision analysis was performed from the perspective of a national health payer, with a 1-year time horizon among women representative of the US screening population aged 40 to 79 years. Three primary outcomes were assessed: (1) incremental costs, (2) number of benign biopsies avoided, and (3) number of missed opportunities for diagnosing cancer per million women screened. Input parameters were obtained from the medical literature and expert opinion. Sensitivity analyses were performed to evaluate the effects of uncertainty in parameter estimates.


RESULTS
The base-case analysis demonstrated that the use of an adjunct diagnostic test with 95% sensitivity, 75% specificity, and a cost of $1,000 would eliminate 8,127 unnecessary breast biopsies per million women screened. However, this would cost the US health care system an additional $6,462,977 and result in 255 missed opportunities for diagnosing cancer per million women screened.


CONCLUSIONS
The addition of an adjunct test for triaging women for breast biopsy after abnormal findings on screening mammography would likely eliminate many unnecessary biopsies but also increase overall health care costs. This exploratory analysis highlights the fact that mammography remains a relatively inexpensive and effective breast cancer screening and diagnostic modality.
Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington. Electronic address: stophlee@uw.edu.
Christoph I
CI
Lee
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Mark E
ME
Bensink
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Kristin
K
Berry
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Zahra
Z
Musa
GE Healthcare, Pollards Wood, United Kingdom.
Carolyn
C
Bodnar
GE Healthcare, Pollards Wood, United Kingdom.
Robert
R
Dann
Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
Jeffrey G
JG
Jarvik
Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Constance D
CD
Lehman
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
Scott D
SD
Ramsey
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000191:economics* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003363:Cost Control / Q000191:economics / Q000379:methods; D020000:Decision Support Systems, Clinical / Q000191:economics; D055088:Early Detection of Cancer / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008327:Mammography / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010347:Patient Care Planning / Q000191:economics* / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000191:economics*
Screening mammography; abnormal mammographic results; breast biopsy; false-positive mammographic results