Decision analysis for the cost effectiveness of Sestamibi Scintimammography in minimizing unnecessary biopsies

Background. The purpose of this study was to assess if breast cancer screen ing using sestamibi scintimammography (SSMM) in conjunction with mammograph y (MM) is cost effective ill avoiding biopsies in healthy patients. Methods. Quantitative decision tree sensitivity analysis was used to compar e the conventional MM alone strategy (strategy A) with two decision strateg ies for screening with SSMM; SSMM after an indeterminate mammogram (strateg y B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per p atient and the average Life expectancy per patient for baseline values as w eb as over a range of values for all of the variables of each strategy. Results. Based on Medicare reimbursement values, strategies B and C showed a cost savings of $9 and $20 per patient respectively as compared to strate gy A. This translates into respective savings of $189 and $420 million per year assuming 21 million females undergo screening each year. Strategies B and C did however have a loss of mean life expectancy of 0.000178 and 0.000 222 years respectively as compared to strategy A due to interval progressio n of breast cancer in a small number of women. Strategies B and C significa ntly lowered the number of biopsies performed on healthy patients in the sc reening population by 750,063 and 1,557,915 biopsies respectively as compar ed to strategy A. Conclusions. These results quantitatively verify the potential utility of u sing SSMM in avoiding unnecessary biopsies.