BMC Health Services Research
Background: Breast cancer in the U.S. - estimated at 232,670 incident cases in 2014 - has the highest aggregate economic burden of care relative to other female cancers. Yet, the amount of cost attributed to diagnostic/ preoperative work up has not been characterized. We examined the costs of imaging and biopsy among women enrolled in Medicare who did and did not receive diagnostic/preoperative Magnetic Resonance Imaging (MRI). Methods: Using Surveillance, Epidemiology and End Results (SEER)- Medicare data, we compared the per capita costs (PCC) based on amount paid, between diagnosis date and primary surgical treatment for a breast cancer diagnosis (2005 – 2009) with and without diagnostic/preoperative MRI. We compared the groups with and without MRI using multivariable models, adjusting for woman and tumor characteristics. Results: Of the 53,653 women in the cohort, within the diagnostic/preoperative window, 20 % ( N = 10,776) received diagnostic/preoperative MRI. Total unadjusted median costs were almost double for women with MRI vs. without ($2,251 vs. $1,152). Adjusted costs were higher among women receiving MRI, with significant differences in total costs ($1,065), imaging costs ($928), and biopsies costs ($138). Conclusion: Costs of diagnostic/preoperative workups among women with MRI are higher than those without. Using these cost estimates in comparative effectiveness models should be considered when assessing the benefits and harms of diagnostic/preoperative MRI.
Onega, Tracy; Tosteson, Anna N.A; Weiss, Julie; Alford-Teaster, Jennifer; Hubbard, Rebecca A.; Henderson, Louise M.; Kerlikowske, Karla; Goodrich, Martha E.; O'Donoghue, Cristina; Wernli, Karen J.; DeMartini, Wendy B.; and Virnig, Beth A., "Costs of Diagnostic and Preoperative Workup With and Without Breast Mri in Older Women with a Breast Cancer Diagnosis" (2016). Open Dartmouth: Faculty Open Access Articles. 2610.