OBJECTIVES: In the UK, anti-angiogenesis (AA) drugs (e.g. bevacizumab) have not been accepted as good value for money within the general metastatic breast cancer (MBC) population. However, it may benefit some subpopulations within MBC. Angiogenesis-specific imaging tests (A-IT) under development have the potential to offer earlier, accurate determination of response to AA therapies for MBC patients, and lower treatment costs. METHODS: A decision-tree-based model was developed to estimate the likely economic impact of A-IT from start of AA therapy through to progression of disease.  Key decision nodes were presence/absence of A-IT, sensitivity/specificity (SE/SP) of A-IT, clinician adherence to test results and treat/no treat decision. Key model inputs (and base case values): 1) median time to progression [TTP] for current MBC patients on AA therapies (9.5 months); 2) median TTP for A-IT identified responders (13 months); 3) costs of bevacizumab, one cycle (£3,591); 4) costs of hemorrhaging, per event (£9,681); 5) per patient costs for diagnostic (£3,826); 6) estimated SE/SP of diagnostic – 95%/75%; 7) clinician adherence to test results (75%).  RESULTS: Based on a hypothetical cohort of MBC patients, base case results indicate that use of A-IT after just one cycle of AA therapy results in savings of £3,570 per patient versus a scenario where A-IT was not used. One-way threshold sensitivity analysis shows A-IT is cost-saving if SP ≥ 62% or when clinician adherence is ≥ 63%. Results were insensitive to changes in SE.  CONCLUSIONS: Use of A-IT could allow for cost-effective use of AA therapies in subgroups of MBC patients due to the earlier, more accurate determination of clinical benefit. Further research is required to assess if A-IT allows AA therapy to become acceptably cost-effective treatment for general MBC in the UK.