The cost-utility of magnetic resonance imaging for breast cancer in BRCA1 mutation carriers aged 30–49
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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. The addition of MRI to this costs £13,486 per QALY. For a 40- to 49-year-old cohort, the corresponding values were £2,913 and £7,781. 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.
KeywordsBRCA1 MRI Mammography Surveillance Cost-utility
We thank the NICE Familial Breast Cancer Guideline Development Group, and Ingolf Greibsch and the MARIBS team, for the supply of various costing figures. We also thank Jo Lord, Anne Spencer, Kees van Gool and the three anonymous referees for their helpful advice on previous drafts. This work was funded through the National Institute for Health and Clinical Excellence (NICE) Guideline Development Process.
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