Screening breast MRI results in more downstream healthcare costs than mammography alone
Women who undergo breast cancer screening via MRI experience more downstream healthcare costs than those who receive mammography alone, according to research published Wednesday in JAMA Network Open.
Physicians have increasingly deployed magnetic resonance imaging to monitor for the disease, particularly among those at high risk or with dense tissue. However, MR imaging of individuals at low or average risk for breast cancer poses potential problems, including excess costs, false positives and unnecessary biopsies.
Researchers recently sought to measure the scope of such low-value care using commercial claims data from 9,200 women who underwent screening MRI. They matched their info up against 9,200 more women imaged with mammography alone and unearthed stark differences. Magnetic resonance recipients received about 39 more subsequent care services per 100 patients than those scanned via mammo alone. That included five additional imaging tests per 100 women, 17 more procedures, 13 extra visits, and about 0.34 hospitalizations.
“The additional testing and related insurer and out-of-pocket spending has important implications for understanding the benefits and harms of MRI screening at the population level and for assisting women in shared decision making about MRI screening,” leader author Ishani Ganguli, MD, an assistant professor at Harvard Medical School, and colleagues concluded. “Our findings underscore the importance of avoiding screening breast MRI in low or average-risk women for whom potential harms from screening outweigh potential benefits.”
Researchers gathered their findings from IBM’s MarketScan database, offering claims and administrative information from large U.S. employers and commercial payers. Those who met the study criteria were between the ages of 40-64, without prior breast cancer, and received screening imaging between 2017-2018. Along with additional services, MRI recipients also experienced higher breast care costs ($564 per woman), overall healthcare expenditures ($1,404), and out-of-pocket spending ($31). Those in the magnetic resonance screening group also received nearly 20 added services (per 100 women) outside of breast care, at an average cost of $42 per person.
While the numbers seem modest, they can add up, the authors noted. Using estimates from other studies and 2020 census data, would equal about $53.4 million in additional total breast care spending stemming from MRI and $4 million more on extramammary services.
“These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms,” the authors advised.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.