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Breast Imaging: Robyn L. Birdwell, Parul Bandodkar, and Debra M. Ikeda Computer-aided Detection with Screening Mammography in a University Hospital Setting Radiology 2005; 236: 451-457 [Abstract] [Full text] [PDF]

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Cost-effectiveness of CAD Is Crucial

Stefano Ciatto   (10 October 2005)

Cost-effectiveness of CAD Is Crucial 10 October 2005
Stefano Ciatto, Head of Dept. Diagnostic Imaging Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy Send letter to journal: Re: Cost-effectiveness of CAD Is Crucial s.ciatto{at}cspo.it Stefano Ciatto	Editor: The study by Birdwell et al (1) shows a limited benefit with use of CAD in terms of detection rate, thus confirming what has been an almost monotonous (and therefore convincing) finding in most retrospective and prospective studies of CAD efficacy; however, it does not solve the problem of its real cost-effectiveness, which remains the key question to be answered before CAD can be recommended as a routine procedure. The relative increase in detection rate achieved with CAD is usually rather small, often (as in the Birdwell at al study) statistically not significant. It would have been interesting to know the extra cost for each cancer detected with CAD. This might be relevant, considering the cost of the machine (even if properly amortized), the workload involved in digitizing more than 8000 films and display CAD prompts for review, the increased workload for radiologists to read more than 8000 films with the help of CAD, the cost of extra referrals for diagnostic assessments generated by CAD (73 in the present study, for two extra cancers detected). CAD costs depend on the modality used for mammography (digital or analog). The cost of CAD-assisted reading of screen-film mammograms (assuming equipment amortization and film-digitizing workload) might be substantially higher, and possibly unacceptable, compared with the cost of CAD software implemented on a digital mammography workstation, with CAD marks displayed directly on the monitor. A careful cost-benefits analysis of CAD is urgently needed and should be properly addressed in future studies of CAD efficacy. Reference 1. Birdwell RL, Bandodkar P, Ikeda DM. Computer-aided detection with screening mammography in a university hospital setting. Radiology 2005; 236:451-457.