Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Department of Hematology and Oncology, School of Medicine, Winship Cancer Institute, Emory University, Atlanta, USA.
BMC Health Services Research (Impact Factor: 1.66). 01/2009; 9:9. DOI: 10.1186/1472-6963-9-9
Source: PubMed

ABSTRACT Breast magnetic resonance imaging (MRI) is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high. The purpose of this study was to determine if breast MRI is a cost-effective approach for the detection of breast cancer among young women at high risk.
A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. All costs and benefits were discounted at 5% per year. The analysis was performed from the payer perspective with results reported in 2006 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters.
Breast MRI provided 14.1 discounted quality-adjusted life-years (QALYs) at a discounted cost of $18,167 while mammography provided 14.0 QALYs at a cost of $4,760 over 25 years of screening. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $179,599/QALY. In univariate analysis, breast MRI screening became < $50,000/QALY when the cost of the MRI was < $315. In the probabilistic sensitivity analysis, MRI screening produced a net health benefit of -0.202 QALYs (95% central range: -0.767 QALYs to +0.439 QALYs) compared to mammography at a willingness-to-pay threshold of $50,000/QALY. Breast MRI screening was superior in 0%, < $50,000/QALY in 22%, > $50,000/QALY in 34%, and inferior in 44% of trials.
Although breast MRI may provide health benefits when compared to mammographic screening for some high risk women, it does not appear to be cost-effective even at willingness to pay thresholds above $120,000/QALY.

Download full-text


Available from: Christopher R Flowers, Jun 29, 2015
1 Follower
  • Wiener klinische Wochenschrift 02/1998; 110(3):69-71. · 0.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Screening (early detection of disease in asymptomatic groups of persons) with whole-body MR (wb-MR) has only recently become possible. Technical requirements include extended scanner table range and extended coverage with surface coils. This allows for examining the whole body without repositioning the patient. wb-MR angiography can be combined with cerebral and cardiac MR to form a comprehensive screening protocol for atherosclerosis; and many malignancies can technically be screened for, such as colonic, bronchial, or renal carcinoma. The prerequisites for suited target diseases include enhanced therapeutic options if the disease is detected in an early stage, they should be harmful if detected late, and they should be sufficiently prevalent. The first studies on wb-MR screening reported low prevalences of a variety of assessable pathologies in non-selected groups; prevalences, however, increase with the presence of risk factors. More recent results are suggestive of a potential prognostic impact of MR screening, but studies on the outcome have not yet been published. This article also discusses potential problems and limitations of wb-MR. Some tumour entities cannot sufficiently be assessed, although the structures are included in the field of view. Incidental findings have to be anticipated; they might have an unforeseeable impact on the subject's well being. wb-MR seems technically 'ready' for screening. The cost-benefit relation of wb-MR screening, however, especially the impact on the health of the screened subjects, still remains to be investigated.
    European journal of radiology 05/2009; 70(3):452-62. DOI:10.1016/j.ejrad.2009.02.011 · 2.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this paper, we designed a Computer-Aided-Diagnosis (CAD) system for lesion detection in breast MR images. The CAD process begins with analysis of MR images to detect the existence of lesion. If lesion exists, it is then coloured based on its type; benign, suspicious or malignant. Our CAD system enables better visualization of the lesions and improves accuracy as well as speed for breast cancer diagnosis.