For women with a family history of breast cancer, magnetic resonance imaging (MRI) every 18 months between the ages of 35 and 60 is a cost-effective screening strategy, according to results from a study published in JAMA Oncology (2020. doi:10.1001/jamaoncol.2020.2922).
In order to assess the cost-effectiveness of MRI screening strategies, H. Amarens Geuzinge, MSc, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues performed an economic evaluation between February 1, 2019 and May 25, 2020.
Microsimulation modeling was used to estimate costs and effectiveness on a lifetime horizon from age 25 years until death. The cohort included 10 million Dutch women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant.
Several screening protocols with varying intervals and ages were examined including mammography protocols (annual mammography and clinical breast examination) and MRI protocols (annual MRI and clinical breast examination plus biennial mammography).
The main outcomes were to calculate costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). A threshold of €22,000 ($24,795.87) per QALY was applied.
On a lifetime horizon per 1000 women, researchers estimated that screening with mammography protocols would detect 346 breast cancers and 49 women would die from the disease, resulting in 22,885 QALYs and total costs of €7,084,767 ($7,985,134.61). Screening with MRI protocols resulted with 79 additional QALYs and total costs of €2,657,266 ($2,994,964.65).
When applying the National Institute for Health and Care Excellence threshold, MRI performed every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of €21,380 ($24,097.08). Additionally, researchers noted that annual screening alternating MRI and mammography, followed by the national screening program, gave similar outcomes.
“This study suggests that MRI screening every 18 months between the ages of 35 and 60 years for women with a family history of breast cancer is cost-effective within the National Institute for Health and Care Excellence threshold for all densities,” wrote Ms Geuzinge and colleagues, noting that higher thresholds would favor annual MRI screening.
“These outcomes support a change of current screening guidelines for this specific risk group and support MRI screening,” they concluded.—Janelle Bradley
