Moore SG, Shenoy PJ, Fanucchi L, Tumeh JW, Flowers CRCost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population. BMC Health Serv Res 9: 9

Department of Hematology and Oncology, School of Medicine, Winship Cancer Institute, Emory University, Atlanta, USA.
BMC Health Services Research (Impact Factor: 1.71). 01/2009; 9(1):9. DOI: 10.1186/1472-6963-9-9
Source: PubMed


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
  • Source
    • "The ICER calculated in this study is higher than previously published cost-effectiveness estimates from the UK, but lower than those from the US [20-22,24]. In the UK study by Norman et al., women were screened for only 10 years, beginning at age 30 or 40 years, giving ICERS of approximately CAD$17,600 and $30,600 per QALY [24]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting. We constructed a Markov model of annual MRI and mammography screening for BRCA1/2 carriers, using local data and published values. We calculated cost-effectiveness as cost per quality-adjusted life-year gained (QALY), and conducted one-way and probabilistic sensitivity analysis. The incremental cost-effectiveness ratio (ICER) of annual mammography plus MRI screening, compared to annual mammography alone, was $50,900/QALY. After incorporating parameter uncertainty, MRI screening is expected to be a cost-effective option 86% of the time at a willingness-to-pay of $100,000/QALY, and 53% of the time at a willingness-to-pay of $50,000/QALY. The model is highly sensitive to the cost of MRI; as the cost is increased from $200 to $700 per scan, the ICER ranges from $37,100/QALY to $133,000/QALY. The cost-effectiveness of using MRI and mammography in combination to screen for breast cancer in BRCA1/2 mutation carriers is finely balanced. The sensitivity of the results to the cost of the MRI screen itself warrants consideration: in jurisdictions with higher MRI costs, screening may not be a cost-effective use of resources, but improving the efficiency of MRI screening will also improve cost-effectiveness.
    Full-text · Article · Jul 2013 · BMC Cancer
  • Source
    • "They also conclude that the cost effectiveness of combining MRI with MMG is highly dependent on the age of the patient. Moore et al10 argue that breast MRI does not appear to be a cost effective screening option for high-risk women. Using a Markov decision model to compare annual breast cancer screening with either breast MRI or MMG over a period of 25 years in high risk women, they determined that it does not appear to be cost effective at a willingness-to-paythreshold of $USD50,000/QALY (quality-adjusted-life- years). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Breast cancer incidence is increasing worldwide. Early detection is critical for long-term patient survival, as is monitoring responses to chemotherapy for management of the disease. Magnetic resonance imaging and spectroscopy (MRI/MRS) has gained in importance in the last decade for the diagnosis and monitoring of breast cancer therapy. The sensitivity of MRI/MRS for anatomical delineation is very high and the consensus is that MRI is more sensitive in detection than x-ray mammography. Advantages of MRS include delivery of biochemical information about tumor metabolism, which can potentially assist in the staging of cancers and monitoring responses to treatment. The roles of MRS and MRI in screening and monitoring responses to treatment of breast cancer are reviewed here. We rationalize how it is that different histological types of breast cancer are differentially detected and characterized by MR methods.
    Full-text · Article · Apr 2013 · Magnetic Resonance Insights
  • Source
    • "For women aged 50- 69 years, mammography has been shown to lower the risk of dying from breast cancer by 35% [4]. In addition it has shown to be highly cost-effective for women in this age group [5]. In light of the evidence available, the International Agency for Research on Cancer expert working group (IARC Working Group, [6]) advises that mammography screening should be offered as a public health policy directed to women aged 50-69 every two years in order to reduce the risk of death from breast cancer. "
    [Show abstract] [Hide abstract]
    ABSTRACT: On the basis of the Survey of Health, Ageing, and Retirement (SHARE), we analyse the determinants of who engages in mammography screening focusing on European women aged 50-69 years. A special emphasis is put on the measurement error of subjective life expectancy and on the measurement and impact of physician quality. Our main findings are that physician quality, better education, having a partner, younger age and better health are associated with higher rates of receipt. The impact of subjective life expectancy on screening decision substantially increases after taking measurement error into account. JEL Classification C 36, I 11, I 18
    Full-text · Article · Apr 2012
Show more