A study on the cost effectiveness of sestamibi scintimammography for screening women with dense breasts for breast cancer

The potential impact of Sestamibi scintimammography (SSMM) on the cost effe ctive management of women with dense breasts is not known. This study addre sses this issue quantitatively by examining the impact of SSMM based screen ing strategies on the similar to 3,000,000 women over 40 with very dense br easts (DY patterns) without palpable masses and who have had one or more pr ior mammograms, who undergo routine screening each year. Quantitative decis ion tree sensitivity analysis was used to compare the conventional mammogra phy (MM) strategy (strategy A), which does not subject patients with negati ve mammograms to any further examination until their next screening, with t wo decision strategies for screening with SSMM SSMM after a negative mammog ram (strategy B) or SSMM as the only screening test for women already ident ified as having dense breasts by a previous mammogram (strategy C). Cost ef fectiveness was measured by calculating the incremental cost effectiveness ratio (ICER) of strategies B and C, which is the cost of achieving an addit ional year of life in the screening population by choosing a SSMM based dec ision strategy rather than the conventional strategy. Strategies B and C re duced the number of false negative diagnoses by 62% and 8%, respectively. T he ICER was $632,000 and $3.18M per life year for strategy B and C, respect ively. To be cost effective, the pre-test probability of cancer in the stud y population must be greater than 3% for strategy B or the cost of SSMM mus t be less than $50 for strategy C. These results show the ICER of an SSMM b ased breast cancer screening strategy in the management of patients with de nse breasts is not currently within the range (similar to$50,000 per year l ife saved) of other commonly performed medical interventions that are consi dered cost effective.