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

Arden M. Morris, Christopher R. Flowers, Katherine T. Morris, Waldemar A. Schmidt, Rodney Pommier, John Vetto

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)962-971
    Number of pages10
    JournalMedical Care
    Volume41
    Issue number8
    DOIs
    StatePublished - Aug 2003

    Fingerprint

    Cost-Benefit Analysis
    Breast
    Costs and Cost Analysis
    costs
    Biopsy
    Mammography
    Fine Needle Biopsy
    Physical Examination
    Relative Value Scales
    evaluation
    management
    Neoplasms
    Cost Savings
    examination
    Medicare
    Ultrasonography
    savings
    diagnostic
    cancer
    Breast Neoplasms

    Keywords

    • Breast
    • Cancer
    • Cost-effectiveness analysis
    • Economic
    • Outcomes
    • Palpable breast mass
    • Screening
    • Triple test

    ASJC Scopus subject areas

    • Nursing(all)
    • Public Health, Environmental and Occupational Health
    • Health(social science)
    • Health Professions(all)

    Cite this

    Comparing the cost-effectiveness of the triple test score to traditional methods for evaluating palpable breast masses. / Morris, Arden M.; Flowers, Christopher R.; Morris, Katherine T.; Schmidt, Waldemar A.; Pommier, Rodney; Vetto, John.

    In: Medical Care, Vol. 41, No. 8, 08.2003, p. 962-971.

    Research output: Contribution to journalArticle

    Morris, Arden M. ; Flowers, Christopher R. ; Morris, Katherine T. ; Schmidt, Waldemar A. ; Pommier, Rodney ; Vetto, John. / Comparing the cost-effectiveness of the triple test score to traditional methods for evaluating palpable breast masses. In: Medical Care. 2003 ; Vol. 41, No. 8. pp. 962-971.
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    abstract = "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.",
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    AU - Flowers, Christopher R.

    AU - Morris, Katherine T.

    AU - Schmidt, Waldemar A.

    AU - Pommier, Rodney

    AU - Vetto, John

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    N2 - 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.

    AB - 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.

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