Image-guided Procedure Versus 2-year Follow-up for a BI-RADS 3 Probably Benign Lesion: A Cost Comparison Analysis

Area of Science:

• Radiology
• Health Economics
• Breast Imaging

Background:

• Breast imaging findings classified as Breast Imaging Reporting and Data System (BI-RADS) category 3 indicate probably benign lesions.
• Management decisions for BI-RADS 3 findings involve a balance between avoiding unnecessary invasive procedures and ensuring timely diagnosis.
• The cost-effectiveness of different management strategies is crucial for healthcare resource allocation.

Purpose of the Study:

• To compare the costs associated with a 2-year imaging follow-up versus immediate image-guided breast procedures for BI-RADS 3 findings.
• To analyze cost differences based on imaging modality (mammography, ultrasound, MRI) and procedure type.

Main Methods:

• National payment amounts for non-facility locations were obtained from the Centers for Medicare and Medicaid Services physician fee schedule.
• Costs for 2-year imaging follow-up (2018-2019) were calculated and compared to costs of image-guided procedures performed in 2018 for BI-RADS 3 lesions.
• Analyses included stereotactic, ultrasound-guided, and MRI-guided biopsy costs.

Main Results:

• Two-year mammographic follow-up for a BI-RADS 3 finding cost $484, significantly less than stereotactic biopsy ($1055+).
• Two-year ultrasound follow-up cost $615, compared to $1173 for ultrasound-guided biopsy.
• MRI follow-up ($1510) was less expensive than most MRI-guided biopsies, except for average-risk patients without post-biopsy MRI ($1235).

Conclusions:

• In 2018-2019, a 2-year imaging follow-up strategy for BI-RADS 3 findings remained more cost-effective than immediate image-guided procedures.
• The primary exception was MRI-guided biopsy in average-risk populations not requiring a subsequent follow-up MRI.
• These findings support the continued use of surveillance for select probably benign breast lesions to optimize healthcare costs.