Does breast biopsy marker cost and availability influence utilisation in radiology practice?

Abstract

Introduction: Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate whether BBM cost and availability impacts BBM utilisation. Methods: An online survey was disseminated to radiologists who identified 'breast imaging' as their area of practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use. Results: Most (92%, 245/266) participants report that BBMs are routinely available at their place of practice. Those employed in private practice were more likely to report that BBMs are not routinely available. 22% (58/266) of radiologists report that BBM cost influences choice of biopsy type (core biopsy vs fine needle aspirate), this finding was more frequent in those employed in private practice. 47% of respondents report that the cost of BBMs is passed on to the patient, with all these respondents employed in a private or mixed private/public setting. Half the respondents (133/266) reported that their decision to use BBMs would be influenced by the availability of insurance coverage to cover BBM costs. Conclusions: Results suggest that BBM cost and availability influences both choice of biopsy type (core biopsy vs FNA) and choice to use a BBM. Radiologists working in private practice or mixed private/public practice report that BBMs are less likely to be available for use, and that BBM cost is more likely passed to the patient; possibly disadvantaging patients who present to private radiology providers with imaging findings or conditions that would indicate BBM insertion under current national guidelines.

Editorial Commentary: Does breast biopsy marker cost and availability influence utilisation in radiology practice

“…I commend the authors for undertaking this important survey of the usage of Breast Biopsy Marker Clips (BBM) in Australia and New Zealand. 1 As the authors indicate, the use of marker clips is a contemporary internationally accepted standard of breast biopsy practice, 2 and regular post biopsy marker clip deployment for small impalpable lesions has been a BreastScreen Australia Clinical Practice Guideline since 2018. 3 The most pressing reason why the routine use of BBM is a standard of care for women undergoing percutaneous biopsy of small screen detected and incidental lesions is the high occurrence of loss of conspicuity of the lesion post biopsy.…”

“…The timely article by Dr Rose Radic and Dr Donna Taylor supports the argument that a Medicare rebate to cover the cost of BBM is overdue in Australia. 1…”

“…I commend the authors for undertaking this important survey of the usage of Breast Biopsy Marker Clips (BBM) in Australia and New Zealand 1 …”