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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 Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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  ECONOMICS OF NUCLEAR MEDICINE
Guest Editor: Gambhir S. S.


The Quarterly Journal of Nuclear Medicine 2000 June;44(2):168-85

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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