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Cost-effectiveness of abbreviated-protocol MRI screening for women with mammographically dense breasts in a national breast cancer screening program

Authors :
Jing Wang
Marcel J.W. Greuter
Karin M. Vermeulen
Frank B. Brokken
Monique D. Dorrius
Wenli Lu
Geertruida H. de Bock
​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE)
Value, Affordability and Sustainability (VALUE)
Life Course Epidemiology (LCE)
Damage and Repair in Cancer Development and Cancer Treatment (DARE)
Source :
Breast, Vol 61, Iss, Pp 58-65 (2022), The Breast, 61, 58-65. Churchill Livingstone, The Breast : Official Journal of the European Society of Mastology
Publication Year :
2022
Publisher :
Elsevier BV, 2022.

Abstract

Introduction Magnetic resonance imaging (MRI) has shown the potential to improve the screening effectiveness among women with dense breasts. The introduction of fast abbreviated protocols (AP) makes MRI more feasible to be used in a general population. We aimed to investigate the cost-effectiveness of AP-MRI in women with dense breasts (heterogeneously/extremely dense) in a population-based screening program. Methods A previously validated model (SiMRiSc) was applied, with parameters updated for women with dense breasts. Breast density was assumed to decrease with increased age. The base scenarios included six biennial AP-MRI strategies, with biennial mammography from age 50–74 as reference. Fourteen alternative scenarios were performed by varying screening interval (triennial and quadrennial) and by applying a combined strategy of mammography and AP-MRI. A 3% discount rate for both costs and life years gained (LYG) was applied. Model robustness was evaluated using univariate and probabilistic sensitivity analyses. Results The six biennial AP-MRI strategies ranged from 132 to 562 LYG per 10,000 women, where more frequent application of AP-MRI was related to higher LYG. The optimal strategy was biennial AP-MRI screening from age 50–65 for only women with extremely dense breasts, producing an incremental cost-effectiveness ratio of € 18,201/LYG. At a threshold of € 20,000/LYG, the probability that the optimal strategy was cost-effective was 79%. Conclusion Population-based biennial breast cancer screening with AP-MRI from age 50–65 for women with extremely dense breasts might be a cost-effective alternative to mammography, but is not an option for women with heterogeneously dense breasts.<br />Highlights • AP-MRI can be cost-effective for screening women with extremely dense breast. • The more frequent the use of AP-MRI, the more life years will be gained. • Biennial AP-MRI for women with extremely dense breast up to age 65 is optimal.

Details

ISSN :
09609776
Volume :
61
Database :
OpenAIRE
Journal :
The Breast
Accession number :
edsair.doi.dedup.....330cf3c5c7a6ebc3d312beb6837abef6
Full Text :
https://doi.org/10.1016/j.breast.2021.12.004