LAUSR

Introduction: Contrast-enhanced spectral mammography (CESM) is a functional imaging technique with comparable accuracy to MRI for loco-regional staging of breast cancer. This study assesses the cost impact of switching from CE-MRI to CESM for loco-regional staging of breast cancer from a public healthcare perspective. Methods: The CE-MRI cost was obtained from NHS reference cost. The CESM cost was calculated using a bottom-up approach including use of the machine, pump injector, contrast, image storage and clinical staff time for reporting and cannulation. The cost of upgrading existing machines to CESM or purchasing new mammographic machines were 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/annum), the cost savings of switching from CE-MRI to CESM range from 64,069 to 81,570 GBP. For small health boards (<500 cancers diagnosed/annum), the cost savings of switching from CE-MRI to CESM range from 6,453 to 23,953 GBP. 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.