Comparing the cost-effectiveness of the triple test score to traditional methods for evaluating palpable breast masses

BACKGROUND. Physical examination, mammography, ultrasonography, and fine needle aspiration are traditionally used to guide further management of palpable breast masses, often leading to open biopsy of benign masses. The triple test score (ITS) integrates physical examination, mammography, and fine needle aspiration in the initial evaluation, limiting open biopsy. OBJECTIVE. To compare cost-effectiveness of TTS and traditional methods. METHODS. The primary measure of clinical effectiveness, frequency of missed malignancy, was determined for each strategy using probabilities and outcomes from a systematic literature review. Costs were calculated using the Medicare resource-based relative-value scale. A decision-analytic model compared costs of initial work-up, costs per mass evaluated, and costs per malignancy diagnosed. Sensitivity analyses assessed the influence of variations in model assumptions. RESULTS. In the base case, neither strategy led to undiagnosed breast cancer. However, open biopsy was required in 13% of benign masses using TTS versus 88% using the traditional strategy. The cost of the initial work-up using traditional management was less than TTS ($377 vs. $627), but cost per mass evaluated and cost per malignancy diagnosed ($1793 vs. $925 and $5670 vs. $2925) favored TTS, due to substantially reduced open biopsy. In sensitivity analyses, TTS cost varied most with changes in cost of initial evaluation, whereas the traditional strategy cost varied most with changes in open biopsy cost. CONCLUSIONS. The TTS provides equivalent diagnostic effectiveness but substantially lower cost than traditional management. Cost savings are based on decreased open biopsy, a major contributor to the cost of traditional evaluation in this model.