The cost-utility of magnetic resonance imaging for breast cancer in BRCA1 mutation carriers aged 30–49 |
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| Authors: | Richard P. A. Norman D. Gareth Evans Douglas F. Easton Kenneth C. Young |
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| Affiliation: | (1) Centre for Health Economic Research and Evaluation (CHERE), University of Technology Sydney, P.O. Box 123, Broadway, Sydney, NSW 2007, Australia;(2) Centre for Health Sciences Barts and the London Queen Mary’s School of Medicine and Dentistry, 2 Newark Street, Whitechapel, London, E1 2AT, UK;(3) Breast Cancer Family History Clinic, Nightingale Centre, Withington Hospital, South Manchester University Hospital Trust, Manchester, UK;(4) Academic Unit of Medical Genetics and Regional Genetics Service, St. Mary’s Hospital, Hathersage Road, Manchester, M13 0JH, UK;(5) Cancer Research UK Genetic Epidemiology Unit, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK;(6) National Co-ordination Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, GU2 7XX, UK |
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| Abstract: | Recent evidence has investigated the cost-effectiveness of magnetic resonance imaging (MRI) in younger women with a BRCA1 mutation. However, this evidence has not been contrasted with existing cost-effectiveness standards to determine whether screening is appropriate, given limited societal resources. We constructed a Markov model investigating surveillance tools (mammography, MRI, both in parallel) under a National Health Service (NHS) perspective. The key benefit of MRI is that increased sensitivity leads to early detection, and improved prognosis. For a 30- to 39-year-old cohort, the cost per quality-adjusted life year (QALY) of mammography relative to no screening was 5,200 pounds. The addition of MRI to this costs 13,486 pounds per QALY. For a 40- to 49-year-old cohort, the corresponding values were 2,913 pounds and 7,781 pounds. Probabilistic sensitivity analysis supported the cost-effectiveness of the parallel approach of mammography and MRI. It is necessary to extend this analysis beyond BRCA1 carriers within this age group, and also to other age groups. |
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| Keywords: | BRCA1 MRI Mammography Surveillance Cost-utility |
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