The Real Cost of Unnecessary Breast Biopsies

Photo: Mel B.

Articles on the health-care industry are a fertile source of large numbers and, sometimes, large errors. In the article “Study of Breast Biopsies Finds Surgery Used Too Extensively,” (New York Times, Feb. 18), it is estimated that nationally 300,000 women a year may be getting unnecessary surgery at a cost of “hundreds of millions of dollars.” I was happy to believe the figure of 300,000 women a year. However, the cost set off my number-sense alarm.

My first mental step was to convert that cost, which is far beyond human experience (at least, far beyond mine), into one that I could judge. A per-person cost is likely to be human-sized. Thus, let’s divide:

“hundreds of millions of dollars” / 300,000 surgical biopsies

To make the mental arithmetic easy, I translate “hundreds” to 300. Then the extra cost is $1,000 per surgical biopsy.

But that figure seems ridiculously low! Once I had to get an ultrasound at a leading Boston hospital. Cost: $1,000. Doing a surgical procedure must cost a lot more than a simple ultrasound, especially in 2011 (my ultrasound was in 2005).

Later in the article, the surgical cost is given: “Hospitals charge $5,000 to $6,000 for a needle biopsy, and double that for an open?[surgical] biopsy…” The doctor’s fees add roughly another $1,000 to the cost of a needle biopsy, and $2,000 to the cost of a surgical biopsy. So, the extra cost of a surgical biopsy is, say: $5,500 (extra hospital cost) + $1,000 (physician cost) = $6,500.

That’s a factor of 6.5 larger than $1,000 per surgery. So the more likely extra cost is $300 million times 6.5 or $2 billion!


AZ

Even if others don't get it, at least people who work with numbers should know that $6,500 is not 6.5 times larger than $1000; it's 6.5 times as large (or 5.5 times larger).

Caitlyn

It may be worth checking what the doctors and hospitals actually get *paid* - insurance companies routinely "adjust" the prices on the bills they receive. (My father is a physician, and he's dealt with this for years. Also, my husband and I currently have an HSA, so we sometimes see such medical bills post-adjustment. A reduction of 60-70% seems to be common.)

mosiffmochephus

Just where is all this Extra money they take going, and is that why the prices keep going up to a emergency visit at the Hospital's, and how are these errors being justified? Why is there so many staff members sitting at the desks and why is it they get every procedure on you they can possibly come up with done before they release you? I know their insurance premiums are high but this is ridiculous! They are like a Butcher with a heavy finger on the scales trying to squeeze everything they can get from you. Is this to counter the 30,000,000 or more illegals they have to subsidize?

Ian Mason

Out of curiosity I went and researched what the British NHS would charge you for those procedures, if you were in a situation that you were charged (NHS treatment is normally free at the point of delivery for British nationals).

Fine Needle Biopsy of Breast ?244 (i.e. 244 GBP)
I couldn't find a tariff price for a surgical biopsy.
Ultrasound depends on type (and you didn't specify) and will cost you ?32.41, ?73.82 or ?146.29 (the latter is for Doppler).

Speed

Now you need to calculate the cost per person-hour for the techs, nurses and physicians.

Marty Nemko

And what about the fear and anxiety costs?

Tabitha

a few billions here and a few billions there...adds up fast

Jackson

By "hundreds of millions," they must have meant "twenty hundred million."

john

What about the cost--not as easily quantifiable, of suffering and possibly death--of a necessary biopsy that wasn't done. Is a biopsy that reveals no disease always considered unnecessary?

Joshua Northey

That cost cuts both ways, and for a lot of these preventative screenings catching it earlier does not actually lead to a long er life, just a longer life knowing you have the disease.

If group A screen at 50 lives to be 58 and has an average life expectancy of 8 years after screening, and group B screened at 40 lives to be 58 and has an average life expectancy of 18 years after screening. Screeners will sell that as though the screening is improving outcomes by 10 years, when really it is just catching things earlier and having no effect at all.

Obviously it is not that simple, but the long and short of it is that with current technology a lot of cancer screenings are counterproductive (for example prostate exams on very old men who will almost certainly die of something else before this slow moving cancer gets them).

JoelP

Two things:
1. Back-of-the-envelope math you are using overstates the potential savings. Because the needle biopsies require radiologic equipment they must be done in a hospital; the excisional biopsies can be done in a surgical clinic.

2. There are actually good reasons why some women are choosing excisional biopsies over needle biopsies. First, many women want that lump *out*. Sure, it's easy for doctors and numbercrunchers to say "the pathology says it's probably benign so you should just leave it" - but some women psychologically really want that mass out. Second, surgeons are able to provide much better continuity of care than the radiologists that perform the needle biopsies.

So in a vacuum it's easy to say "this procedure is being overused", but in practice there is actually a good reason women choose the "wrong" one. The NY Times article linked (which implies this is all about money) is poorly researched.

Read more...

KLee

My surgeon performs his own needle biopsies in his own office, as do many of them nowadays.

Patty

Right on! I do this all the time and keep a few numbers memorized like the population of the US, the world, the national debt, the diameter of the Earth, distance to the moon etc. so I can put other numbers into context. It really helps.

laurichj

An ultrasound is more like $150 (I just paid for one). What they bill and what they receive are quite different.

KLee

Actually I just had a diagnostic breast ultrasound and the cost was only $72 at a local imaging center. Also, I am now scheduled to have a biopsy in the Doctor's Office, which will be anywhere from $450 to $850 dollars. The reason you are coming up with such high costs are because Hospitals charge enormous fees to use their operating rooms, equipment, etc... For instance, my son was scheduled for dental surgery and the hospital charge for "use of the operating room for less than 1 hour was $5000! The solution is simple... don't go to the hospital if you can find a doctor that can perform the procedure in his office. Many surgeons are well equipped to do just that, and many others are now building their own "surgery centers" to avoid paying the outrageous rental fees to the hospitals!

Cal

I'm researching this topic right now because I recently underwent a breast biopsy; a core needle biopsy, mind you, not an open incision. When I read the invoice from my insurance provider, I became breathless.

The charges from the hospital? $17,714!

Warren Redlich

The savings is the difference between cost of open biopsy and of needle biopsy, not biopsy or no biopsy. Still, the difference in cost appears to be more like $3K, not $1K.