Breast Cancer Screening by MRI cost-effective for females with genetic risk
In women with a family history of breast cancer, regular magnetic resonance imaging (MRI) screening for every 18 months between the ages 35 and 60yrs is cost effective, finds a study. The study was published in the journal, 'JAMA Oncology' 2020.
There are
various screening guidelines for women with a 20% or more familial risk of
breast cancer without a known BRCA1/2 or TP53 variant and these guidelines vary
substantially. The cost-effectiveness analyses are also very scarce. The
economic evaluation was conducted from February 1, 2019, to May 25, 2020. A
Dutch screening setting was modeled and a microsimulation modelling was used to
estimate costs and effectiveness on a lifetime horizon from age 25 years until
death of the MRI screening among a cohort of 10 million Dutch women with a 20%
or more familial risk for breast cancer without a known BRCA1/2 or TP53
variant. Data was obtained from the randomized Familial MRI Screening (FaMRIsc)
trial, which included Dutch women aged 30 to 55 years. A health care payer
perspective was applied.
Several screening protocols including the randomized FaMRIsc trial, which
consisted of the mammography and the MRI protocol were used. Main outcome of
measurement were costs, life-years, quality-adjusted life-years (QALYs), and
incremental cost-effectiveness ratios (ICERs) which were calculated and
discounted by 3%. A threshold of €22 000 (US $24 795.87) per QALY was applied.
The key
findings of the study are:
This economic evaluation modeling study estimated that, on a lifetime horizon
per 1000 women with the Mx protocol of the FaMRIsc trial, 346 breast cancers
would be detected, and 49 women were estimated to die from breast cancer,
resulting in 22 885 QALYs and total costs of €7 084 767 (US $7 985 134.61).
The MRI protocol resulted in 79 additional QALYs and additional €2 657 266 (US $2 994 964.65).
Magnetic resonance imaging performed only every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of €21 380 (US $24 097.08) compared with the previous nondominated strategy in the ranking, when applying the National Institute for Health and Care Excellence threshold.
Annual screening alternating magnetic resonance imaging and mammography between the ages of 35 and 60 years, followed by the national screening program, gave similar outcomes.
Higher thresholds would favor annual magnetic resonance imaging screening.
The ICER was most sensitive to the unit cost of magnetic resonance imaging (MRI) and the utility value for ductal carcinoma in situ and localized breast cancer.
Thus, the researchers concluded that MRI screening every 18 months between the
ages of 35 and 60 years for women with a family history of breast cancer is
cost-effective within the National Institute for Health and Care Excellence
threshold for all densities. They further added that Higher thresholds would
favor annual magnetic resonance imaging (MRI) screening and also that These
outcomes should support a change of current screening guidelines for this
specific risk group and support MRI.