Cost minimization analysis of ultrasound-guided diagnostic evaluation of probably benign breast lesions

The objective of this study was to compare direct health care costs for two competing diagnostic strategies for probably benign breast lesions detected by ultrasound in young women. We developed a decision analytic model and performed a cost minimization analysis comparing ultrasound-guided vacuum-assisted core biopsy and conservative short-term diagnostic ultrasound follow-up. Relative probabilities for diagnostic outcomes were derived from pooled analysis of the medical literature. Direct health care costs were estimated using United States national average figures from calendar year 2010. Deterministic sensitivity analyses were conducted, as well as a first-order Monte Carlo simulation to confirm cost differences between the two strategies. The conservative short-term imaging follow-up strategy ($639.55 average cost per patient) was the most economical strategy compared to immediate vacuum-assisted core biopsy ($879.55 average cost per patient). Sensitivity analyses demonstrated that the preferred strategy is most dependent on the probabilities of detecting change in appearance on follow-up ultrasound, having a benign finding on immediate core biopsy, and finding cancer on a biopsy triggered by an interval change in ultrasound appearance. The model was also sensitive to the costs of vacuum-assisted core biopsy and diagnostic ultrasound. Conservative imaging follow-up of BIRADS 3 breast masses by ultrasound is cost saving compared to immediate vacuum-assisted core biopsy, with a potential of saving more than one-third of overall costs associated with the diagnostic work-up of such lesions. Watchful waiting with short-term interval follow-up ultrasounds will spare women from unnecessary procedures and spare the United States health care system from unnecessary direct health care costs.