Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening.

Matthias F. Froelich,Johann Rink,Moritz L. Schnitzer,Johannes Rübenthaler,Matthias Dietzel,Fabian Tollens,Pascal A. T. Baltzer,Clemens G. Kaiser,Wolfgang G. Kunz

doi:10.3389/fonc.2021.724543

Abstract

ObjectivesTo evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.MethodsDecision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.ResultsBreast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.ConclusionsBased on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.

Highlights

In line with current recommendations, MR-mammography (MRM) has been clinically accepted for various indications such as screening women at high risk for breast cancer, diagnostic evaluation in cancer of unknown primary, and as a problem solver in special cases [1, 2].Recent data has hinted towards a role of MRM in an extended set of indications, such as screening women at intermediate risk of breast cancer due to their elevated density of breast tissue
Data on the first screening round of the DENSE trial indicated an incremental cost-effectiveness ratio (ICER) of two-yearly MRM screening below $ 10,000 per quality-adjusted life years (QALYs) gained as previously published in our model-based costeffectiveness analysis [6]
Over the time frame of 20 years, the strategy MRM resulted in average cumulative costs of $ 6,081 per woman and average cumulative effects of 15.12 QALYs, whereas screening with x-ray mammography (XM) resulted in costs of $ 5,810 and 15.10 QALYs (Table 2)

Summary

Introduction

In line with current recommendations, MR-mammography (MRM) has been clinically accepted for various indications such as screening women at high risk for breast cancer, diagnostic evaluation in cancer of unknown primary, and as a problem solver in special cases [1, 2]. Recent data has hinted towards a role of MRM in an extended set of indications, such as screening women at intermediate risk of breast cancer due to their elevated density of breast tissue. The Dutch parliament has lately decided to introduce MRM as a screening tool for women of intermediate risk due to their breast density as the first country to recommend so [7]. Modern concepts of economic studies are increasingly being applied to evaluate diagnostic strategies in screening

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