Cost-Effectiveness of Screening Women With Familial Risk for Breast Cancer With Magnetic Resonance Imaging.

Saadatmand S, Tilanus-Linthorst MM, Rutgers EJ, Hoogerbrugge N, Oosterwijk JC, Tollenaar RA, Hooning M, Loo CE, Obdeijn IM, Heijnsdijk EA, de Koning HJ.

Source

Affiliations of authors: Department of Surgery (SS, MMAT-L), Department of Radiology (I-MO), and Department of Public Health (EAMH, HJdK), Erasmus Medical Center, Rotterdam, Netherlands; Department of Surgery, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands (EJTR); Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands (NH); Department of Genetics, University Medical Center, Groningen University, Groningen, Netherlands (JCO); Department of Surgery, Leiden University Medical Center, Leiden, Netherlands (RAEMT); Department of Medical Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (MH); Department of Radiology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands (CEL).

Abstract

BACKGROUND:

To reduce mortality, women with a family history of breast cancer are often screened with mammography before age 50 years. Additional magnetic resonance imaging (MRI) improves sensitivity and is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history without a proven mutation, cost-effectiveness is unclear.

METHODS:

We evaluated data of the largest prospective MRI screening study (MRISC). Between 1999 and 2007, 1597 women (8370 woman-years at risk) aged 25 to 70 years with an estimated cumulative lifetime risk of 15% to 50% for breast cancer were screened with clinical breast examination every 6 months and with annual mammography and MRI. We calculated the cost per detected and treated breast cancer. After incorporating MRISC data into a microsimulation screening analysis model (MISCAN), different schemes were evaluated, and cost per life-year gained (LYG) was estimated in comparison with the Dutch nationwide breast cancer screening program (biennial mammography from age 50 to 75 years). All statistical tests were two-sided.

RESULTS:

Forty-seven breast cancers (9 ductal carcinoma in situ) were detected. Screening with additional MRI costs $123 672 (€93 639) per detected breast cancer. In increasing age-cohorts, costs per detected and treated breast cancer decreased, but, unexpectedly, the percentage of MRI-only detected cancers increased. Screening under the MRISC-scheme from age 35 to 50 years was estimated to reduce breast cancer mortality by 25% at $134 932 (€102 164) per LYG (3.5% discounting) compared with 17% mortality reduction at $54 665 (€41 390) per LYG with mammography only.