A recent analysis reports a cost-effective alternative modality that demonstrates similar efficacy to traditional breast magnetic resonance imaging (MRI), published in the American Journal of Roentgenology (June 2017;208:W231-W237).
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Prior research has shown that screening mammography helps reduce breast cancer and mortality. In high-risk patients with specific BRCA mutations or dense breasts, MRI is often used. However, breast MRI often fails to identify calcifications and can induce a significant cost burden on patients.
Bhavika K Patel, MD, department of radiology, Mayo Clinic Hospital (Phoenix, AZ), and colleagues conducted a cost-effective analysis comparing breast MRI with contrast-enhanced digital mammography (CEDM) – which generates a high-resolution, low-energy, full field digital mammography image and a contrast-enhanced image that provides information on lesion vascularity.
Initially, researchers examined the effectiveness of CEDM before initiating their comparative analysis. The required equipment for CEDM requires only “straightforward” installation. “Existing mammographic equipment can be modified with relative ease to enable CEDM, possibly increasing patient access to contrast-enhanced breast imaging at minimal incremental cost while improving clinical resource efficiency,” they wrote.
Additionally, researchers cited previous research that indicated lower false-positive rates for CEDM compared with breast MRI. CEDM has also improved microcalcification visualization on low-energy images, according to previous research.
After comparing the cost-effectiveness of CEDM and breast MRI, researchers found CEDM to be significantly less expensive. Researchers believe this finding may be due to the full field digital mammography received by patients who receive breast MRI but not be those who receive CEDM. Furthermore, breast MRI requires more time than CEDM, which negatively impacts the facility’s bottom line.
“When the American Cancer Society issued screening MRI guidelines in 2007, it was estimated that as many as 1.4 million women would qualify for breast MRI screening,” the authors wrote. “If CEDM were deemed a viable substitute for breast MRI…the savings would be approximately $750 per examination and as much as $1.1 billion annually. If only a portion of the women in the breast MRI screening population were to qualify for CEDM, there would still be the potential for substantial efficiencies.”—Zachary Bessette
