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[Cost-effectiveness of MR-imaging in the preoperative work-up of suspicious breast lesions].

UNLABELLED
Cost-effectiveness of MR-imaging in the preoperative work-up of suspicious breast lesions.


PURPOSE
To assess the clinical and economic consequences of a preoperative magnetic resonance mammography (MRM) in patients with suspicious breast lesions.


PATIENTS AND METHODS
483 out of 2426 patients operated because of breast neoplasms at the University Hospital of Jena between August 1995 and March 1999 underwent preoperative Gd-enhanced breast MRI in addition to mammography and breast ultrasound because of suspicious breast lesions. The histological assessment was correlated with the results of the diagnostic imaging work-up in 447 cases. The costs of surgery for malignant lesions were calculated based on case- dependent billing agreements, costs of surgery of benign lesions were calculated based on current billing procedure. In 36 cases no surgery was performed due to the exclusion of malignancy by breast MRI. 140 benign lesions were treated surgically in spite of negative breast MRI diagnosis. The hospitalization time related costs caused by these cases were compared to the costs of preoperative MR-imaging.


RESULTS
The total costs for MR mammography in all 483 patients amounted to DM 499,857. In 11 cases false positive results in MRM led to additional costs of DM 32,565. Assuming that there is no need for surgical treatment of benign breast lesions, total savings of DM 521,048 due to avoided hospitalization in 176 cases could have been possible. The savings per patient amount in these 176 cases are DM 2,960.50 compared to DM 1,034.90 costs for breast MRI.


CONCLUSION
Despite the currently still high costs of breast MRI a major cost reduction can be achieved by prevention of unnecessary surgery, avoidance of additional surgery and associated trauma for patients.