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Cost-effectiveness of MR Imaging and Core-Needle Biopsy in the Preoperative Work-up of Suspicious Breast Lesions¹

¹ From the School of Medicine (J.M.H.), the Departments of Radiology (J.M.H., C.P.L., S.G.O., M.D.S.) and Medicine (K.R.F., J.S.S.), the Center for Clinical Epidemiology and Biostatistics (C.P.L.), and the Leonard Davis Institute of Health Economics (C.P.L., J.S.S.), University of Pennsylvania Medical Center, Philadelphia. From the 1997 RSNA scientific assembly. Received September 29, 1997; revision requested November 26; final revision received January 27, 1999; accepted April 30. Supported in part by National Institutes of Health grants R01-CA58358 and R29-LM06238, U.S. Army grant RP950855, U.S. Department of Health and Human Services grant RFP #282-96-0026, and an American Heart Association Student Research Fellowship. Address reprint requests to C.P.L., 5 Biddle Way, Mount Laurel, NJ 08054 (e-mail: langlotz@erols.com).

PURPOSE: To assess the clinical and economic consequences of the use of preoperative breast magnetic resonance (MR) imaging and core-needle biopsy (CNB) to avert excisional biopsy (EXB).

MATERIALS AND METHODS: A decision-analytic Markov model was constructed to compare MR imaging, CNB, and EXB without preoperative testing in a woman with a suspicious breast lesion. Stage-specific cancer prevalence, tumor recurrence, progression rates, and MR imaging and CNB sensitivity and specificity were obtained from the literature. Cost estimates were obtained from the literature and from the Medicare fee schedule.

RESULTS: EXB without preoperative testing was associated with the greatest quality-adjusted life expectancy, followed by MR imaging and CNB; life expectancies were 17.409, 17.405, and 17.398 years, respectively. EXB resulted in the greatest lifetime treatment cost ($31,438), followed by MR imaging ($29,072) and CNB ($28,573). Results were robust over a wide range of cancer prevalence, stage distribution, tumor progression rates, and procedure and treatment costs. Incremental cost-effectiveness ratios showed that preoperative testing was cost-effective, but the choice between MR imaging and CNB was highly dependent on the accuracy of each test and to patient preferences.

CONCLUSION: Preoperative testing of most suspicious breast lesions was cost-effective. More precise estimates of MR imaging and CNB test performance characteristics are needed. Until those are available, patient preferences should inform individual decisions regarding preoperative testing.

Index terms: Breast, biopsy, 00.1261, 00.1267 • Breast neoplasms, diagnosis, 00.30 • Breast neoplasms, MR, 00.1214 • Cost-effectiveness, 00.1214, 00.1261, 00.1267 • Economics, medical

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