Cost-effectiveness of MR Imaging and Core-Needle Biopsy in the Preoperative Work-up of Suspicious Breast Lesions

Hrung, Janie M.; Langlotz, Curtis P.; Orel, Susan G.; Fox, Kevin R.; Schnall, Mitchell D.; Schwartz, J. Sanford

doi:10.1148/radiology.213.1.r99oc5139

Cited by 38 publications

(25 citation statements)

References 80 publications

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“…The patient is asked to trade-off extended time with the condition being diagnosed or treated in order to avoid the noxious effects of the test or treatment in favour of a similarly effective test or treatment but one not having side-effects [22]. A QALY toll is reflected in the wait-trade-off by an individual's willingness to wait longer to avoid more noxious experiences [23] and may be measured by disutility, being the fraction of a year of perfect health a patient would be willing to give up to avoid having to undergo a diagnostic test and to avoid its short-term morbidity [24]. This tool was originally designed for use in states related to diagnostic screening and testing [25].…”

Section: Cost-effectivenessmentioning

confidence: 99%

Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis

2012

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Selection of the optimal procedure for minimally invasive diagnosis of peripheral pulmonary lesions (PPLs) may be based on clinical factors; however, selection of diagnostic strategy may also be influenced by cost. Economic analysis of minimally invasive diagnosis of PPL has not been performed previously.Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasoundguided transbronchial lung biopsy (EBUS-TBLB) with computed tomography-guided percutaneous needle biopsy (CT-PNB). Calculations were based on real costs derived from patient data. Sensitivity analyses and probabilistic sensitivity analysis were undertaken to identify the more cost-beneficial approach for varying input parameter values. Cost-effectiveness calculations were based on estimated disutility, according to the wait-trade-off technique.For base-case analysis, initial evaluation with CT-PNB was cost-beneficial (AU$2,724 versus EBUS-TBLB AU$2,748). The variable which exerted the most influence on cost-benefit outcomes was the cost of managing complications. CT-PNB remained the more cost-effective procedure at base-case parameters, although thresholds were identified during sensitivity analysis where EBUS-TBLB became more cost-effective.The costs of EBUS-TBLB and CT-PNB to evaluate PPL appear to be equivalent, but specific clinicalradiologic factors known to influence procedural outcomes will influence cost-benefit outcomes. Further evaluation of patient preferences and their influence on cost-effectiveness are required.

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Section: Cost-effectivenessmentioning

confidence: 99%

Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis

2012

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“…In order to inform the selection of health status attributes and their levels, literature detailing the functional health and HRQoL impact of various diagnostic procedures was also consulted [5,8,16,24].…”

Section: Development Of Attributes and Itemsmentioning

confidence: 99%

“…We interviewed breast biopsy patients, given society's interest in this procedure and its cost-effectiveness [5,6]. All participants were women (N = 76) who were approached prospectively with the permission of the treating oncologist at their initial follow-up appointments.…”

Section: Development Of Attributes and Itemsmentioning

confidence: 99%

“…However, short-term effects, such as the morbidity of diagnostic testing and screening, may influence the results of cost-effectiveness analysis, as has been suggested in breast biopsy and MR angiography [5][6][7]. Such information may also be useful for patients, families, and practitioners in the context of shared decision making, and could be used as another metric for some processes of medical care.…”

Section: Introductionmentioning

confidence: 99%

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Initial development of the Temporary Utilities Index: a multiattribute system for classifying the functional health impact of diagnostic testing

et al. 2010

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“…A decision analytic approach based on data obtained from literature suggested that core biopsy and open-breast biopsy may be clinically equivalent, core biopsy being less costly than openbreast biopsy (Hrung et al, 1999). Prior to our study, actual direct empirical comparison of the diagnostic procedures had not been performed.…”

mentioning

confidence: 99%

Cost-effectiveness of stereotactic large-core needle biopsy for nonpalpable breast lesions compared to open-breast biopsy

et al. 2004

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This paper demonstrates that the introduction of large-core needle biopsy (LCNB) replacing needle-localised breast biopsy (NLBB) for nonpalpable (screen-detected) breast lesions could result in substantial cost savings at the expense of a possible slight increase in breast cancer mortality. The cost-effectiveness of LCNB and NLBB was estimated using a microsimulation model. The sensitivity of LCNB (0.97) and resource use and costs of LCNB and NLBB were derived from a multicentre consecutive cohort study among 973 women who consented in getting LCNB and NLBB, if LCNB was negative. Sensitivity analyses were performed. Replacing NLBB with LCNB would result in approximately six more breast cancer deaths per year (in a target population of 2.1 million women), or in 1000 extra life-years lost from breast cancer (effect over 100 years). The total costs of management of breast cancer (3% discounted) are estimated at d4676 million with NLBB; introducing LCNB would save d13 million. The incremental cost-effectiveness ratio of continued NLBB vs LCNB would be d12 482 per additional life-year gained (3% discounted); incremental costs range from d-21 687 (low threshold for breast biopsy) to d74 378 (high sensitivity of LCNB).

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Cost-effectiveness of MR Imaging and Core-Needle Biopsy in the Preoperative Work-up of Suspicious Breast Lesions

Abstract: Preoperative testing of most suspicious breast lesions was cost-effective. More precise estimates of MR imaging and CNB test performance characteristics are needed. Until those are available, patient preferences should inform individual decisions regarding preoperative testing.

Cited by 38 publications

References 80 publications

Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis

Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis

Initial development of the Temporary Utilities Index: a multiattribute system for classifying the functional health impact of diagnostic testing

Cost-effectiveness of stereotactic large-core needle biopsy for nonpalpable breast lesions compared to open-breast biopsy

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