title: The cost-utility of magnetic resonance imaging for breast cancer in BRCA1 mutation carriers aged 30-49.
abstract: 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.
authors.affiliation: 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
authors.forename: Richard P A
authors.initials: RP
authors.lastname: Norman
authors.forename: D Gareth
authors.initials: DG
authors.lastname: Evans
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Easton
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Young
mesh_terms: 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*