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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Rivista di Medicina Nucleare e Imaging Molecolare
A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
ECONOMICS OF NUCLEAR MEDICINE
Guest Editor: Gambhir S. S.
The Quarterly Journal of Nuclear Medicine 2000 June;44(2):168-85
Decision analysis for the cost effectiveness of Sestamibi Scintimammography in minimizing unnecessary biopsies
Allen M. W., Hendi P., Schwimmer J., Bassett L. *, Gambhir S. S.
From the Crump Institute for Biological Imaging and Department of Molecular & Medical Pharmacology the Division of Nuclear Medicine and Department of Biomathematics and *Iris Cantor Center for Breast Imaging Department of Radiology UCLA School of Medicine, Los Angeles, California, USA
Background. The purpose of this study was to assess if breast cancer screening using sestamibi scintimammography (SSMM) in conjunction with mammography (MM) is cost effective in avoiding biopsies in healthy patients.
Methods. Quantitative decision tree sensitivity analysis was used to compare the conventional MM alone strategy (strategy A) with two decision strategies for screening with SSMM; SSMM after an indeterminate mammogram (strategy B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per patient and the average life expectancy per patient for baseline values as well 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 strategy 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 0.000222 years respectively as compared to strategy A due to interval progression of breast cancer in a small number of women. Strategies B and C significantly lowered the number of biopsies performed on healthy patients in the screening population by 750,063 and 1,557,915 biopsies respectively as compared to strategy A.
Conclusions. These results quantitatively verify the potential utility of using SSMM in avoiding unnecessary biopsies.