The cost-utility of magnetic resonance imaging for breast cancer in BRCA1 mutation carriers aged 30-49.
Recent evidence has investigated the cost-effectiveness of magnetic resonance imaging (MRI) in younger women with a BRCA1 mutation. However, this evidence has not been contrasted with existing cost-effectiveness standards to determine whether screening is appropriate, given limited societal resources. We constructed a Markov model investigating surveillance tools (mammography, MRI, both in parallel) under a National Health Service (NHS) perspective. The key benefit of MRI is that increased sensitivity leads to early detection, and improved prognosis. For a 30- to 39-year-old cohort, the cost per quality-adjusted life year (QALY) of mammography relative to no screening was 5,200 pounds. The addition of MRI to this costs 13,486 pounds per QALY. For a 40- to 49-year-old cohort, the corresponding values were 2,913 pounds and 7,781 pounds. Probabilistic sensitivity analysis supported the cost-effectiveness of the parallel approach of mammography and MRI. It is necessary to extend this analysis beyond BRCA1 carriers within this age group, and also to other age groups.
Norman
Richard P A
RP
Centre for Health Economic Research and Evaluation, University of Technology Sydney, P.O. Box 123, Broadway, Sydney, NSW 2007, Australia. richard.norman@chere.uts.edu.au
Evans
D Gareth
DG
Easton
Douglas F
DF
Young
Kenneth C
KC
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D019398:Genes, BRCA1; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008390:Markov Chains; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*