Cost-benefit analysis of biopsy methods for suspicious mammographic lesions

Hypothesis: Stereotactic core biopsy (SCB) is more cost-effective than need le-localized biopsy (NLB) for evaluation and treatment of mammographic lesi ons. Design: A computer-generated mathematical model was developed based on clin ical outcome modeling to estimate costs accrued during evaluation and treat ment of suspicious mammographic lesions. Total costs were determined for ev aluation and subsequent treatment of cancer when either SCB or NLB was used as the initial biopsy method. Cost was estimated by the cumulative work re lative value units accrued. The risk of malignancy based on the Breast Imag ing Reporting Data System (BIRADS) score and mammographic suspicion of duct al carcinoma in situ were varied to simulate common clinical scenarios. Main Outcome Measures: Total cost accumulated during evaluation and subsequ ent surgical therapy (if required). Results: Evaluation of BIRADS 5 lesions (highly suggestive, risk of maligna ncy =90%) resulted in equivalent relative value units for both techniques ( SCB, 15.54; NLB, 15.47). Evaluation of lesions highly suspicious for ductal carcinoma in situ yielded similar total treatment relative value units (SC B, 11.49; NLB, 10.17). Only for evaluation of BIRADS 4 lesions (suspicious abnormality, risk of malignancy=34%) was SCB more cost-effective than NLB ( SCB, 7.65 vs NLB, 15.66). Conclusions: No difference in cost-benefit was found when lesions highly su ggestive of malignancy (BIRADS 5) or those suspicious for ductal carcinoma in situ were evaluated initially with SCB vs NLB, thereby disproving the hy pothesis. Only for intermediate-risk lesions (BIRADS 4) did initial evaluat ion with SCB yield a greater cost savings than with NLB.