title: Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer. We evaluated the cost-effectiveness of alternative screening strategies involving MRI.
  
  
  METHODS
  Using a microsimulation model, we generated life histories under different risk profiles, and assessed the impact of screening on quality-adjusted life-years, and lifetime costs, both discounted at 3%. We compared 12 screening strategies combining annual or biennial MRI with mammography and clinical breast examination (CBE) in intervals of 0.5, 1, or 2 years vs without, and reported incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  Based on an ICER threshold of $100,000/QALY, the most cost-effective strategy for women at 25% lifetime risk was to stagger MRI and mammography plus CBE every year from age 30 to 74, yielding ICER $58,400 (compared to biennial MRI alone). At 50% lifetime risk and with 70% reduction in MRI cost, the recommended strategy was to stagger MRI and mammography plus CBE every 6 months (ICER=$84,400). At 75% lifetime risk, the recommended strategy is biennial MRI combined with mammography plus CBE every 6 months (ICER=$62,800).
  
  
  CONCLUSIONS
  The high costs of MRI and its lower specificity are limiting factors for annual screening schedule of MRI, except for women at sufficiently high risk.
authors.affiliation: Department of Medicine, Division of Biostatistics, The Dan L. Duncan Cancer Center at Baylor College of Medicine, One Baylor Plaza, BCM600, Houston TX 77030, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Ahern
authors.affiliation: Department of Medicine, Section of Hospital Medicine, The University of Chicago, 5841 S Maryland Avenue, MC 5000, Chicago IL 60637, USA.
authors.forename: Y-C T
authors.initials: YC
authors.lastname: Shih
authors.affiliation: Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1411, Houston TX 77030, USA.
authors.forename: W
authors.initials: W
authors.lastname: Dong
authors.affiliation: 1] Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston MA 02115, USA [2] Department of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston MA 02115, USA.
authors.forename: G
authors.initials: G
authors.lastname: Parmigiani
authors.affiliation: Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1411, Houston TX 77030, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Shen
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D009010:Monte Carlo Method; D012307:Risk Factors