European Radiology

, Volume 18, Issue 11, pp 2390–2397

Utilization and cost of diagnostic imaging and biopsies following positive screening mammography in the southern breast cancer screening region of the Netherlands, 2000–2005


    • Department of RadiologyCatharina Hospital
  • Johanna H. Groenewoud
    • Centre of Expertise Transitions in Care, Hogeschool Rotterdam
  • Jacques Fracheboud
    • Department of Public Health, Erasmus MCUniversity Medical Center Rotterdam
  • Menno L. Plaisier
    • Department of RadiologyMáxima Medical Center
  • Rudi M. H. Roumen
    • Department of SurgeryMáxima Medical Center
  • B. Martin van Ineveld
    • Institute of Health Policy and Management, Erasmus Medical CenterUniversity Medical Center Rotterdam
  • Mike van Beek
    • Regional Laboratory for PathologyPAMM laboratories
  • Harry J. de Koning
    • Department of Public Health, Erasmus MCUniversity Medical Center Rotterdam

DOI: 10.1007/s00330-008-1043-5

Cite this article as:
Duijm, L.E.M., Groenewoud, J.H., Fracheboud, J. et al. Eur Radiol (2008) 18: 2390. doi:10.1007/s00330-008-1043-5


We prospectively assessed trends in utilization and costs of diagnostic services of screen-positive women in a biennial breast cancer screening program for women aged 50–75 years. All 2,062 women with suspicious findings at screening mammography in the southern region of the Netherlands between 1 January 2000 and 1 July 2005 (158,997 screens) were included. Data were collected on any diagnostic examinations, interventional procedures, and surgical consultations with two-year follow-up. We used national reimbursement rates to estimate imaging costs and percutaneous biopsy costs. Cost prices, charged by hospitals, were used to estimate open surgical biopsy costs and surgical consultation costs. The largest increase in utilization of diagnostic procedures per 100 referrals was observed for axillary ultrasound (from 3.9 in 2000 to 33.5 in 2005) and for stereotactic core biopsy (from 2.1 in 2000 to 26.8 in 2005). Per 100 referrals, the open surgical biopsy rate decreased from 34.7 (2000) to 4.6 (2005) and the number of outpatient surgical consultations fluctuated between 269.8 (2000) and 309.7 (2004). Mean costs for the diagnosis of one cancer were €1,501 and ranged from €1,223 (2002) to €1,647 (2003). Surgical biopsies comprised 54.1% of total diagnostic costs for women screened in 2000, but decreased to 9.9% for women screened in 2005. Imaging costs increased from 23.7 to 43.8%, percutaneous biopsy costs from 9.9 to 27.2%, and consultation costs from 12.3 to 19.1%. We conclude that diagnostic costs per screen-detected cancer remained fairly stable through the years, although huge changes in the use of different diagnostic procedures were observed.


MammographyMass screeningDiagnostic techniques and proceduresCosts

Copyright information

© European Society of Radiology 2008