Mehmet U. S. Ayvaci MS, BS, Presenter: Nothing to Disclose

Oguzhan Alagoz PhD, Abstract Co-Author: Nothing to Disclose

Elizabeth S. Burnside MD, MPH, Abstract Co-Author: Nothing to Disclose

Assessing patient outcomes due to a reduction in funding for breast cancer diagnostic decisions is important where resources are limited. We explore the sensitive trade-off between public interest and patient's well being through a novel framework for evaluating the cost-effectiveness of diagnostic procedures after mammography.

We developed a sequential decision making model that optimizes breast cancer diagnostic decisions in the context of various budgetary limitations. That is, given mammography features, demographic factors, and a limited budget, what is the optimal course of action; routine screening, short-term follow-up or biopsy? We derive model parameters using 62,219 consecutive mammography records reported in Breast Imaging Reporting and Data System (BI-RADS) format and the medical literature. By repeatedly maximizing total expected quality adjusted life years (QALYs) at consecutive levels of funding, we form incremental cost-effectiveness ratios. We compare actual clinical practice with optimal decisions obtained from the model over the budget range identified.

Using optimal thresholds for decision making entails lowering the risk threshold used to elect biopsy in younger women as compared raising the thresholds in older women; a policy that would result in 22% cost savings without sacrificing QALYs. Short-term follow-up mammography is the immediate target for elimination when budgetary limits are imposed. Increasing the budget level from lower budget to higher budget has more impact in the risk thresholds of the older age group, yet the gains in total expected QALYs related to larger budgets are predominantly seen in younger women along with modest gains for older women.

Our decision-analytic model suggests age-based thresholds for managing the breast disease after mammography and results in higher effectiveness than existing clinical guidelines. Life gains due to optimal diagnostic decisions are mostly observed in younger women. Our research could potentially serve as a guide for improved diagnostic decisions in either developed countries or in developing countries where resources are limited.

By using our modeling framework, policymakers could assess health outcomes and associated costs of various policies or make resource allocation decisions to improve care.

Ayvaci, M, Alagoz, O, Burnside, E, How Budgetary Restrictions Effect Post-Mammography Management Decisions: An Analytical Model.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11008371.html