Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk

C. H. Ahern, Y. C T Shih, W. Dong, G. Parmigiani, Y. Shen

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1542-1551
Number of pages10
JournalBritish Journal of Cancer
Volume111
Issue number8
DOIs
StatePublished - Oct 14 2014
Externally publishedYes

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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