Cost-effectiveness of MR imaging and core-needle biopsy in the preoperative work-up of suspicious breast lesions

PURPOSE: To assess the clinical and economic consequences of the use of pre operative 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 wi th it suspicious breast lesion. Stage-specific cancer prevalence, tumor rec urrence, progression rates, and MR imaging and CNB sensitivity and specific ity were obtained from the literature. Cost estimates were obtained from th e 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 expe ctancies 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 preoper ative testing was cost-effective, but the choice between MR imaging and CNB was highly dependent on the accuracy of each test and to patient preferenc es. CONCLUSION: Preoperative testing of most suspicious breast lesions was cost -effective. More precise estimates of MR imaging and CNB test performance c haracteristics are needed. Until those are available, patient preferences s hould inform individual decisions regarding preoperative testing.