Cost–Benefit Analyses

Abstract

Only in a few European countries (Switzerland, France, Poland, Belgium, and some local projects in Germany) are minimally invasive breast biopsies (MIBB) reimbursed by health insurance. Public health authorities ask for detailed estimates and calculation of costs as well as laborious, expensive evaluation procedures as the basis for decision making before obliging insurance to provide reimbursement. In Europe, which services insurance companies are required to pay is generally a matter of public policy. However, the following deliberations apply equally to direct negotiations with private or governmental insurers elsewhere. The following sections analyze the generally accepted factors and data to be considered when predicting the numbers and cost of minimally invasive breast biopsy in a given region or country. These include the frequency and circumstances of mammography, the recall rate for abnormal findings on mammography, and the type and distribution of the different follow-up investigations and biopsy procedures performed to clarify these abnormal findings. The distribution of the different biopsy procedures is altered by new procedures being developed and by the pattern of reimbursement on the part of the health insurance entities.