Cost-Effectiveness of MRI Screening for Women With Familial Risk of Breast Cancer in the Netherlands
Annual screening for breast cancer with magnetic resonance imaging (MRI) has been found to be cost-effective in women aged 30 to 60 years who are BRCA1 or BRCA2 carriers or who have a 50% chance of being a carrier, and such screening is recommended in these women by many authorities. It is unclear whether MRI screening is cost-effective in women with a family history of breast cancer without a proven mutation.
In a study reported in the Journal of the National Cancer Institute, Sepideh Saadatmand, MD, of Erasmus Medical Center in Rotterdam, and colleagues analyzed data from a large Dutch prospective screening study (Dutch MRI Screening Study, MRISC) in women with hereditary predisposition to breast cancer to determine cost-effectiveness of annual MRI screening. They found that MRI screening may improve survival for women with familial risk but that it is expensive, particularly in the youngest age categories.
Study Details
In MRISC, 1,597 women (8,370 woman-years at risk) aged 25 to 70 years with an estimated cumulative lifetime risk of 15% to 50% for breast cancer were screened with clinical breast examination every 6 months and annual mammography and MRI between 1999 and 2007. Costs per detected and treated breast cancer were calculated and different screening strategies were modeled to estimate cost per life-year gained compared with the Dutch nationwide breast cancer screening program, which consists of biennial mammography from age 50 to 75 years. Costs were based on current costs in centers in the Netherlands and were calculated in euros and converted to U.S. dollars.
Estimated Costs
Overall, 47 breast cancers, including 9 ductal carcinomas in situ, were detected, and screening with MRI was estimated to cost $123,672 (€93,639) per detected breast cancer and $133,760 €101,277) per detected and treated breast cancer. Costs per detected and treated breast cancer decreased with increasing age cohort: $333,930 (€252,836) in women < 30 years (no cancers detected), $270,677 (€204,944) in those 30 to 39 years, $116,403 (€88,135) in those 40 to 49 years, $91,491 (€69,273) in those 50 to 59 years, and $60,315 (€45,668) in those ≥ 60 years.
Unexpectedly, the proportion of MRI-only detected cancers also increased with increasing age cohort: 1 of 5 (20%) for 30 to 39 years, 7 of 18 (39%) for 40 to 49 years, 6 of 14 (43%) for 50 to 59 years, and 0 of 2 for ≥ 60 years (14 of 39, 36%, overall).
Cost-Effectiveness Analyses
Screening with clinical breast examination every 6 months and annual mammography and MRI in women aged 35 to 50 years followed by biennial mammography until age 75, as in MRISC, was estimated to result in a mortality reduction of 25%, at $134,932 (€102,164) per life-year gained (3.5% discounting) compared with a 17% mortality reduction at $54,665 (€41,390) per life-year gained with mammography only. A strategy of annual screening with MRI followed by mammography and CBE 6 months later was more cost-effective, reducing mortality by 25% at $118,936 (€90,053) per life-year gained.
The most cost-effective MRI screening strategy was alternate year screening with mammography in year 1 followed by MRI in year 2, which was associated with a mortality reduction of 21% at $79,654 (€60,310) per life-year gained. Postponing this alternating scheme until age 40 resulted in a mortality reduction of 18% at $60,267 (€45,631) per life-year gained.
The investigators concluded, “Screening with MRI may improve survival for women with familial risk for breast cancer but is expensive, especially in the youngest age categories…. Still, it may be more cost-effective in select groups.”
The Dutch MRISC study was supported by ZonMw.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
