TY - JOUR
T1 - Cost-effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk
AU - Geuzinge, H. Amarens
AU - Obdeijn, Inge-Marie
AU - Rutgers, Emiel J. T.
AU - Saadatmand, Sepideh
AU - Mann, Ritse M.
AU - Oosterwijk, Jan C.
AU - Tollenaar, Rob A. E. M.
AU - de Roy van Zuidewijn, Diderick B. W.
AU - Lobbes, Marc B. I.
AU - van 't Riet, Martijne
AU - Hooning, Maartje J.
AU - Ausems, Margreet G. E. M.
AU - Loo, Claudette E.
AU - Wesseling, Jelle
AU - Luiten, Ernest J. T.
AU - Zonderland, Harmien M.
AU - Verhoef, Cees
AU - Heijnsdijk, Eveline A. M.
AU - Tilanus-Linthorst, Madeleine M. A.
AU - de Koning, Harry J.
AU - Familial MRI Screening
N1 - Funding Information:
receiving grants, personal fees, and nonfinancial support from Siemens Healthineers; grants and personal fees from Bayer Healthcare; grants from Medtronic, Screenpoint Medical, and BD; and personal fees from Transonic Imaging outside the submitted work. Dr de Koning reported receiving grants from ZonMw during the conduct of the study; personal fees outside the submitted work; and grants on breast cancer control from Rijksinstituut voor Volksgezondheid en Milieu, Cancer Intervention and Surveillance Modelling Network of the National Institutes of Health, and the European Union. No other disclosures were reported. Group Information: The member of the Familial MRI Screening (FaMRIsc) Study group are as follows: Writing committee: H. Amarens Geuzinge (Erasmus University Medical Centre), Inge-Marie Obdeijn (Erasmus University Medical Centre), Eveline A. M. Heijnsdijk (Erasmus University Medical Centre), Emiel J. T. Rutgers (The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital), Sepideh Saadatmand (Erasmus University Medical Centre), Ritse M. Mann (Radboud University Hospital; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital), Jan C. Oosterwijk (Medical Centre Leeuwarden; University Medical Centre Groningen), Rob A. E. M. Tollenaar (Leiden University Medical Centre), Diderick B. W. de Roy van Zuidewijn (Medical Centre Leeuwarden), Marc B. I. Lobbes (Maastricht University Medical Center), Martijne van ‘t Riet (Reinier de Graaf Gasthuis), Maartje J. Hooning (Erasmus University Medical Center), Ingeborg Mares-Engelberts (Vlietland ziekenhuis), Margreet G. E. M. Ausems (University Medical Centre Utrecht), Claudette E. Loo (The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital), Jelle Wesseling (The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital), Ernest J. T. Luiten (University Medical Centre Utrecht), Harmien M. Zonderland (Amsterdam UMC, University of Amsterdam), Cees Verhoef (Erasmus University Medical Centre), Madeleine M. A. Tilanus-Linthorst (Erasmus University Medical Center), and Harry J. de Koning (Erasmus University Medical Center).
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/7/30
Y1 - 2020/7/30
N2 - Importance For women with a 20% or more familial risk of breast cancer without a known BRCA1/2 (BRCA1, OMIM; and BRCA2, OMIM) or TP53 (OMIM) variant, screening guidelines vary substantially, and cost-effectiveness analyses are scarce.Objective To assess the cost-effectiveness of magnetic resonance imaging (MRI) screening strategies for women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant.Design, Setting, and Participants In this economic evaluation, conducted from February 1, 2019, to May 25, 2020, microsimulation modeling was used to estimate costs and effectiveness on a lifetime horizon from age 25 years until death of MRI screening among a cohort of 10 million Dutch women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. A Dutch screening setting was modeled. Most data were obtained from the randomized Familial MRI Screening (FaMRIsc) trial, which included Dutch women aged 30 to 55 years. A health care payer perspective was applied.Interventions Several screening protocols with varying ages and intervals including those of the randomized FaMRIsc trial, consisting of the mammography (Mx) protocol (annual mammography and clinical breast examination) and the MRI protocol (annual MRI and clinical breast examination plus biennial mammography).MAIN OUTCOMES AND MEASURES Costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated and discounted by 3%. A threshold of (sic)22 000 (US $24 795.87) per QALY was applied.RESULTS This economic evaluation modeling study estimated that, on a lifetime horizon per 1000 women with the Mx protocol of the FaMRIsc trial, 346 breast cancers would be detected, and 49 women were estimated to die from breast cancer, resulting in 22 885 QALYs and total costs of (sic)7 084 767 (US $7 985 134.61). The MRI protocol resulted in 79 additional QALYs and additional (sic)2 657 266 (US $2 994 964.65). Magnetic resonance imaging performed only every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of (sic)21 380 (US $24 097.08) compared with the previous nondominated strategy in the ranking, when applying the National Institute for Health and Care Excellence threshold. Annual screening alternating MRI and mammography between the ages of 35 and 60 years, followed by the national screening program, gave similar outcomes. Higher thresholds would favor annual MRI screening. The ICER was most sensitive to the unit cost of MRI and the utility value for ductal carcinoma in situ and localized breast cancer.CONCLUSIONS AND RELEVANCE 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. 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.
AB - Importance For women with a 20% or more familial risk of breast cancer without a known BRCA1/2 (BRCA1, OMIM; and BRCA2, OMIM) or TP53 (OMIM) variant, screening guidelines vary substantially, and cost-effectiveness analyses are scarce.Objective To assess the cost-effectiveness of magnetic resonance imaging (MRI) screening strategies for women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant.Design, Setting, and Participants In this economic evaluation, conducted from February 1, 2019, to May 25, 2020, microsimulation modeling was used to estimate costs and effectiveness on a lifetime horizon from age 25 years until death of MRI screening among a cohort of 10 million Dutch women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. A Dutch screening setting was modeled. Most data were obtained from the randomized Familial MRI Screening (FaMRIsc) trial, which included Dutch women aged 30 to 55 years. A health care payer perspective was applied.Interventions Several screening protocols with varying ages and intervals including those of the randomized FaMRIsc trial, consisting of the mammography (Mx) protocol (annual mammography and clinical breast examination) and the MRI protocol (annual MRI and clinical breast examination plus biennial mammography).MAIN OUTCOMES AND MEASURES Costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated and discounted by 3%. A threshold of (sic)22 000 (US $24 795.87) per QALY was applied.RESULTS This economic evaluation modeling study estimated that, on a lifetime horizon per 1000 women with the Mx protocol of the FaMRIsc trial, 346 breast cancers would be detected, and 49 women were estimated to die from breast cancer, resulting in 22 885 QALYs and total costs of (sic)7 084 767 (US $7 985 134.61). The MRI protocol resulted in 79 additional QALYs and additional (sic)2 657 266 (US $2 994 964.65). Magnetic resonance imaging performed only every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of (sic)21 380 (US $24 097.08) compared with the previous nondominated strategy in the ranking, when applying the National Institute for Health and Care Excellence threshold. Annual screening alternating MRI and mammography between the ages of 35 and 60 years, followed by the national screening program, gave similar outcomes. Higher thresholds would favor annual MRI screening. The ICER was most sensitive to the unit cost of MRI and the utility value for ductal carcinoma in situ and localized breast cancer.CONCLUSIONS AND RELEVANCE 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. 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.
KW - MAMMOGRAPHIC DENSITY
KW - AGE
KW - MRI
KW - LIFE
KW - IMPACT
U2 - 10.1001/jamaoncol.2020.2922
DO - 10.1001/jamaoncol.2020.2922
M3 - Article
C2 - 32729887
SN - 2374-2437
VL - 6
SP - 1381
EP - 1389
JO - JAMA Oncology
JF - JAMA Oncology
IS - 9
ER -