Costing analysis to introduce a contrast-enhanced mammography service to replace an existing breast MRI service for local staging of breast cancer

AIM: To assess the cost impact of switching from contrast-enhanced magnetic resonance imaging (CE-MRI) to contrast-enhanced spectral mammography (CESM) for loco-regional staging of breast cancer from a public healthcare perspective. MATERIALS AND METHODS: The CE-MRI cost was obtained from the NHS reference cost. The CESM cost was calculated using a bottom-up approach including use of the machine, pump injector, contrast medium, image storage, and time allocation for staff reporting and cannu-lation. The cost of upgrading existing machines to CESM or purchasing new mammographic machines was obtained via national procurement. Other costs were obtained from local pharmacy, published unit cost data, or estimated based on surveys. RESULTS: For large health boards in Scotland (>500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from 64,069 pound to 81,570 pound. For small health boards (<500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from 6,453 pound to 23,953 pound. The cost savings are most sensitive to the number of tests conducted per year, and whether the existing mammography machine can be upgraded to CESM or not. CONCLUSION: Switching from CE-MRI to CESM for loco-regional staging of breast cancer is likely to be cost saving for both large and small health boards in Scotland. Further research is urgently needed to confirm the non-inferiority of CESM to CE-MRI as a locoregional staging technique. The input data of this analysis can be updated when such results become available. (c) 2023 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).