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dc.contributor.authorGanguli, Ishani
dc.contributor.authorKeating, Nancy l.
dc.contributor.authorThakore, Nitya
dc.contributor.authorLii, Joyce
dc.contributor.authorRaza, Sughra
dc.contributor.authorPace, Lydia E.
dc.date2022-08-11T08:10:50.000
dc.date.accessioned2022-08-23T17:22:00Z
dc.date.available2022-08-23T17:22:00Z
dc.date.issued2022-04-01
dc.date.submitted2022-07-21
dc.identifier.citation<p>Ganguli I, Keating NL, Thakore N, Lii J, Raza S, Pace LE. Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women. JAMA Netw Open. 2022 Apr 1;5(4):e227234. doi: 10.1001/jamanetworkopen.2022.7234. PMID: 35416989; PMCID: PMC9008498. <a href="https://doi.org/10.1001/jamanetworkopen.2022.7234" target="_blank" title="view article on publisher's site">https://doi.org/10.1001/jamanetworkopen.2022.7234</a></p>
dc.identifier.issn2574-3805
dc.identifier.doi10.1001/jamanetworkopen.2022.7234
dc.identifier.pmid35416989
dc.identifier.urihttp://hdl.handle.net/20.500.14038/48651
dc.description.abstractImportance: Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value. Objective: To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women. Design, Setting, and Participants: This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021. Exposures: Breast MRI vs mammography. Main Outcomes and Measures: Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test. Results: In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55). Conclusions and Relevance: In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.
dc.language.isoen_US
dc.relation<p><a href="https://pubmed.ncbi.nlm.nih.gov/35416989/" target="_blank" title="view article in PubMed">view article in PubMed</a></p>
dc.rightsCopyright 2022 Ganguli I et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectBreast
dc.subjectBreast Neoplasms
dc.subjectCohort Studies
dc.subjectFemale
dc.subjectHumans
dc.subjectMagnetic Resonance Imaging
dc.subjectMale
dc.subjectMammography
dc.subjectMiddle Aged
dc.subjectBreast
dc.subjectBreast Neoplasms
dc.subjectCohort Studies
dc.subjectFemale
dc.subjectHumans
dc.subjectMagnetic Resonance Imaging
dc.subjectMale
dc.subjectMammography
dc.subjectMiddle Aged
dc.subjectHealth Policy
dc.subjectHealth Services Administration
dc.subjectHealth Services Research
dc.subjectRadiology
dc.titleDownstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women
dc.typeJournal Article
dc.source.journaltitleJAMA Network Open
dc.source.volume5
dc.source.issue4
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1730&amp;context=radiology_pubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/radiology_pubs/714
dc.identifier.contextkey30355358
refterms.dateFOA2022-08-23T17:22:00Z
html.description.abstract<p>Importance: Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value.</p> <p>Objective: To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women.</p> <p>Design, Setting, and Participants: This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021.</p> <p>Exposures: Breast MRI vs mammography.</p> <p>Main Outcomes and Measures: Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test.</p> <p>Results: In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55).</p> <p>Conclusions and Relevance: In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.</p>
dc.identifier.submissionpathradiology_pubs/714
dc.contributor.departmentDepartment of Radiology
dc.source.pagese227234


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Copyright 2022 Ganguli I et al. JAMA Network Open.
This is an open access article distributed under the terms of the CC-BY License.
Except where otherwise noted, this item's license is described as Copyright 2022 Ganguli I et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.