The Contrast-Enhanced Mammography (CEM) method has emerged as a crucial tool in breast cancer diagnostics. The recent RACER trial, a randomized controlled clinical study, evaluated CEM’s role compared to conventional imaging for women recalled from a screening program. This trial-based economic evaluation assessed cost-utility from a hospital perspective. CEM demonstrates comparable diagnostic accuracy to traditional methods, but its potential for a more efficient and cost-saving work-up is highly significant. Consequently, understanding its economic advantages is key to global healthcare resource allocation.
Lower Costs and Comparable Quality of Life
The primary economic finding of the RACER trial is compelling. Work-up using CEM resulted in lower overall costs, demonstrating a mean difference of €-117 compared to conventional imaging. Furthermore, average imaging costs were also significantly lower with CEM, showing a mean difference of €-130. Although the mean Quality-Adjusted Life Year (QALY) for the CEM group was similar to the control group, the cost reduction strongly favors CEM. Therefore, the data suggests that CEM offers the same patient outcome at a lower price.
Contrast-Enhanced Mammography in Screening Recalls
The cost-utility analysis showed that most simulated results indicated cost-savings. Approximately 95% of all Incremental Cost-Effectiveness Ratios (ICERs) fell within the quadrants suggesting cost-savings. Moreover, the study calculated a 53% probability that CEM is a cost-effective strategy, even at a low threshold of €10,000 to accept a QALY loss. However, this cost-effectiveness becomes overwhelmingly strong in a specific patient subgroup. Specifically, for women with BI-RADS 0 recalls—which indicates an incomplete but low suspicion finding—the probability of CEM being cost-effective jumps to 85%. Additionally, CEM is widely regarded as a viable substitute for the more costly breast MRI, often being less expensive for both the patient and the healthcare facility. For instance, the use of CEM-guided biopsies is consistently reported as being faster and approximately 45% less costly than MRI-guided biopsies. This highlights major operational efficiencies.
Clinical Relevance and Operational Efficiency
The clinical implication for practitioners is straightforward: CEM should be the primary imaging modality for diagnostic work-up, especially in BI-RADS 0 recalls. Since the diagnostic accuracy of CEM is similar to conventional primary imaging, its efficiency reduces the need for supplemental imaging, which streamlines the entire diagnostic process. The examination time for CEM is much shorter than an MRI, often lasting only about 10 minutes, which improves patient preference and throughput. Considering these operational efficiencies and cost benefits, health systems globally should strongly consider implementing CEM. Therefore, CEM represents a clear step forward in optimizing breast cancer screening follow-up.
Frequently Asked Questions
Q1: What is the main finding of the RACER trial regarding CEM?
The main finding is that Contrast-Enhanced Mammography (CEM) as a primary diagnostic tool in the work-up after screening is a cost-effective strategy that results in lower overall costs with a similar Quality-Adjusted Life Year (QALY) outcome compared to conventional imaging.
Q2: Which specific patient group benefits most from CEM’s cost-effectiveness?
The strategy is most cost-effective for women with BI-RADS 0 recalls, where the probability of CEM being cost-effective is significantly higher (85%) compared to the overall group (53%).
Q3: How does the cost of CEM compare to other advanced diagnostic imaging like breast MRI?
CEM is generally considered a cost-effective alternative to breast MRI. Studies have shown that the cost of screening MRI is substantially higher than CEM, and CEM-guided biopsies can be nearly half the cost of MRI-guided biopsies while also being faster.
References
- Neeter LMFH et al. Cost-effectiveness of contrast-enhanced mammography compared to conventional imaging in the work-up after screening (RACER trial). Eur Radiol. 2025 Dec 24. doi: 10.1007/s00330-025-12195-8. PMID: 41441997.
- Giuliano CL et al. Contrast-Enhanced Mammography in Breast Cancer Screening. Cancers (Basel). 2024 Jan 1;16(1):151.
- Patel BK et al. Contrast-enhanced digital mammography: a cost-effective substitute for breast MRI? AJR Am J Roentgenol. 2017 Aug;209(2):286-291.
- Lobbes MRI et al. Efficiency and diagnostic performance of contrast-enhanced mammography compared with conventional imaging in the work-up after breast cancer screening recall (RACER): a multicentre, randomised controlled clinical trial. Lancet Reg Health Eur. 2024 Sep;44:101183.