Scientists at Emory University, Winship Cancer Institute publish new data on breast cancer risk factors
February 9th, 2009
2009 FEB 9 -- Fresh data on breast cancer are presented in the report 'Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population.' "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," scientists writing in the journal BMC Health Services Research report.
"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," wrote S.G. Moore and colleagues, Emory University, Winship Cancer Institute.
The researchers concluded: "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."
Moore and colleagues published their study in BMC Health Services Research (Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population. BMC Health Services Research, 2009;9():9).
Additional information can be obtained by contacting S.G. Moore, School of Medicine, Dept. of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta USA..
The publisher of the journal BMC Health Services Research can be contacted at: Biomedical Central Ltd., Middlesex House, 34-42 Cleveland St., London W1T 4LB, England.
Keywords: United States, Breast Cancer Risk Factors, Biopsy, Breast Cancer, Breast Cancer Screening, Breast Carcinoma, Breast Carcinoma Screening, Health Policy, Magnetic Resonance, Medicare, Oncology, Surgery, Women's Health.
This article was prepared by Clinical Oncology Week editors from staff and other reports. Copyright 2009, Clinical Oncology Week via NewsRx.com.
