PCN56 Contrast Enhanced Mammography (CEM) VS Contrast Enhanced Breast MRI As a Preoperative Staging EXAM in Women with NEWLY Diagnosed Breast Cancer: A Budget IMPACT Analysis

Abstract

This study estimates the budget impact of introducing contrast enhanced mammography (CEM) as an alternative to breast MRI for preoperative staging in women with newly diagnosed breast cancer. A budget impact model was developed from a commercial US payer perspective with one-year time horizon. A literature search was performed to determine the diagnostic performance and downstream costs after undergoing CEM vs breast MRI. Diagnostic procedure costs were determined using IBM® MarketScan® database. Costs were adjusted to November 2020 US dollars using healthcare specific consumer price indices. In a hypothetical commercial health plan of 5 million members, 28,500 women with newly diagnosed breast cancer were estimated to receive a preoperative staging exam. The mean reimbursement cost was lower for CEM than breast MRI ($551 vs $1,077). Due to increased specificity, the number of false positives (FP) after CEM exam were lower than breast MRI (7,752 vs 10,944), resulting in fewer unnecessary biopsies (651 vs 919) and fewer women receiving more extensive surgery following a FP. As a result, the total additional cost associated with increased biopsies and change in surgical treatment plan due to FP was significantly lower than breast MRI ($52,309,675 vs $73,848,953) resulting in cost savings of $21,539,278 to the health plan. The total mean cost of change in surgical treatment plan due to true positives (TP) were similar in CEM and breast MRI. The net cost savings of undergoing CEM vs breast MRI were $36,530,278 with $1,282 total cost savings per cancer diagnosis and $7.31 total cost savings per member. After performing sensitivity analysis, similar results were obtained compared to base-case study across all tested scenarios. CEM may be a viable substitute to breast MRI for preoperative staging of breast cancer owing to similar sensitivity but higher specificity and lower cost.