In 2006, the U.S. Food and Drug Administration recommended screening of all women with silicone gel breast implants with magnetic resonance imaging 3 years after implantation and every 2 years thereafter to assess their integrity. The cost for these serial examinations over the lifetime of the breast implants is an added burden to insurance payers and to women. The authors performed an economic analysis to determine optimal screening strategies by considering the diagnostic accuracy of the screening tests, costs of the tests, and subsequent implant removal.
The authors determined aggregate/pooled values for sensitivity and specificity of the screening tests of ultrasound and magnetic resonance imaging in detecting silicone breast implant ruptures from the data obtained from published literature. They compiled costs, based on Medicare reimbursements for 2011, for the following elements: imaging modalities, anesthesia, and three surgical treatment options for detected ruptures. A decision tree was used to compare three alternate screening strategies of ultrasound only, magnetic resonance imaging only, and ultrasound followed by magnetic resonance in asymptomatic and symptomatic women.
The cost per rupture of screening and management of rupture with ultrasound in asymptomatic women was $1090; in symptomatic women, it was $1622. A similar cost for magnetic resonance imaging in asymptomatic women was $2067; in symptomatic women it was $2143. A similar cost for ultrasound followed by imaging in asymptomatic women was $637; in symptomatic women, it was $2908.
Screening with ultrasound followed by magnetic resonance imaging was optimal for asymptomatic women, and screening with ultrasound was optimal for symptomatic women.
Ann Arbor, Mich.
From the Section of Plastic Surgery, The University of Michigan Medical School; the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; and the Center for Statistical Consultation and Research, University of Michigan.
Received for publication January 10, 2012; accepted February 2, 2012.
Disclosure:The authors have no financial interest in any of the products or devices mentioned in this article.
Kevin C. Chung, M.D., M.S.; 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, The University of Michigan Health System, Ann Arbor, Mich. 48109-0340, firstname.lastname@example.org