Impact of specificity on cost-effectiveness of screening women at high risk of breast cancer with magnetic resonance imaging, mammography and ultrasound. Issue 137 (April 2021)

• Record Type: Journal Article
• Authors: Kaiser, Clemens G.; Dietzel, Matthias; Vag, Tibor; Rübenthaler, Johannes; Froelich, Matthias F.; Tollens, Fabian
• Is Part Of: European journal of radiology. Issue 137(2021)
• Publication Date: 2021-04
• Subjects: MRM MR-mammography -- US ultrasound -- XM X-ray based mammography -- QALY quality adjusted life year -- QOL quality of life -- WTP willingness to pay -- DBT digital tomosynthesis; MR-Mammography -- Mammography -- Breast cancer -- Ultrasound -- High-Risk screening -- Clinical breast examination; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109576
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: MRM screening resulted in higher cumulative QALYs than x-ray based mammography in the chosen Markov model. MRM is cost-effective compared to x-ray based mammography, based on the conventionally defined willingness to pay of $100, 000 per QALY. In high-risk screening, MR-mammography is diagnostically superior and cost-effective compared to x-ray mammography. Specificity has a significant economical impact in high risk screening (yearly screening intervals). Our data suggest a re-evaluation of the role of ultrasound in high-risk screening from an economical perspective. Abstract: Purpose: Aim of this study was to analyze the comparative cost-effectiveness of MR-mammography vs conventional imaging in a screening setting for women with high risk of breast cancer, with particular focus on the impact of specificity of MRM. Method: Decision analytic modelling and Markov Modelling were applied to evaluate cumulative costs of each screening modality and their subsequent treatments as well as cumulative outcomes in quality adjusted life years (QALYs). For the selected time horizon of 30 years, false positive and false negative results were included. Model input parameters for women with high risk of breast cancer were estimated based on published data from a US healthcare system perspective. Major influence factors were identified and evaluated in a deterministic sensitivity analysis. Based on current recommendations for economic evaluations, a probabilistic sensitivity analysis was conducted to test the model stability. Results: In a base-case analysis, screening with XM vs. MRM and treatment resulted in overall costs of $36, 201.57 vs. $39, 050.97 and a cumulative effectiveness of 19.53 QALYs vs. 19.59 QALYs. This led to an incremental cost-effectiveness ratio (ICER) of $ 45, 373.94 per QALY for MRM. US and XM + US resulted in ICER values higher than the willingness to pay (WTP). In the sensitivity analyses, MRM remained a cost-effective strategy for screening high-risk patients as long as the specificity of MRM did not drop below 86.7 %. Conclusion: In high-risk breast cancer patients, MRM can be regarded as a cost-effective alternative to XM in a yearly screening setting. Specificity may be an important cost driver in settings with yearly screening intervals.