The European Journal of Health Economics

, Volume 8, Issue 2, pp 137–144 | Cite as

The cost-utility of magnetic resonance imaging for breast cancer in BRCA1 mutation carriers aged 30–49

  • Richard P. A. Norman
  • D. Gareth Evans
  • Douglas F. Easton
  • Kenneth C. Young
Original paper

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. 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.

Keywords

BRCA1 MRI Mammography Surveillance Cost-utility 

References

  1. 1.
    Griebsch, I., Brown, J., Boggis, C. et al.: Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs. X-ray mammography of women at a high familial risk of breast cancer. Br. J. Cancer 95, 801–810 (2006)CrossRefGoogle Scholar
  2. 2.
    Gold, M.R., Siegel, J.E., Russell, L.B., Weinstein, M.C.: Cost-effectiveness in health and medicine. Oxford University Press, Oxford (1996)Google Scholar
  3. 3.
    Leach, M.O., Boggis, C.R., Dixon, A.K., et al.: Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365, 1769–1778 (2005)CrossRefGoogle Scholar
  4. 4.
    Kerlikowske, K., Grady, D., Barclay, J., et al.: Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA 276, 33–38 (1996)CrossRefGoogle Scholar
  5. 5.
    McIntosh, A., Shaw, C., Evans, G., et al.: Clinical guidelines and evidence review for the classification and care of women at risk of familial breast cancer. Royal College of General Practitioners/University of Sheffield, London (2004)Google Scholar
  6. 6.
    Norman, R., Ritchie, G., Evans, D.G., et al.: Clinical guidelines and evidence review for familial breast cancer: the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care (partial update): routine surveillance using magnetic resonance imaging. Royal College of General Practitioners, London (2006)Google Scholar
  7. 7.
    Plevritis, S.K., Kurian, A.W., Sigal, B.M., et al.: Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA 295, 2374–84 (2006)CrossRefGoogle Scholar
  8. 8.
    Government Actuarial Department figures. Available at http://www.gad.gov.uk/Life_Tables/eoltable.htm
  9. 9.
    Pisano, E.D., Gatsonis, C., Hendrick, E., et al.: Diagnostic performance of digital versus film mammography for breast-cancer screening. New Engl. J. Med. 353, 1773–1778 (2005)CrossRefGoogle Scholar
  10. 10.
    Antoniou, A.C., Pharoah, P.D., Narod, S.: Breast and ovarian cancer risks to carriers of the BRCA1 5382insC and 185delAG and BRCA2 6174delT mutations: a combined analysis of 22 population based studies. Am. J. Hum. Genet. 72, 1117–1130 (2003)CrossRefGoogle Scholar
  11. 11.
    Coleman, M.P., Babb, P., Quinn, M.J., et al.: Socio-economic inequalities in cancer survival in England and Wales. Cancer 91, 208–216 (2001)CrossRefGoogle Scholar
  12. 12.
    Cortesi, L., Chiuri, V.E., Ruscelli, S., et al.: Prognosis of screen-detected breast cancers: results of a population based study. BMC Cancer 6, 17 (2006)Google Scholar
  13. 13.
    Jensen, A.R., Garne, J.P., Storm, H.H., et al.: Stage and survival in breast cancer patients in screened and non-screened Danish and Swedish populations. Acta Oncol. 42, 701–709 (2003)CrossRefGoogle Scholar
  14. 14.
    Yassin, M.M., Peel, A.L.G., Thompson, W.D., et al.: Does screen-detected breast cancer have better survival than symptomatic breast cancer? Asian J. Surg. 26, 101–107 (2003)CrossRefGoogle Scholar
  15. 15.
    Berrington de Gonzalez, A., Reeves, G.: Mammographic screening before age 50 in the UK: comparison of the radiation risks with mortality benefits. Br. J. Cancer 93, 590–596 (2005)CrossRefGoogle Scholar
  16. 16.
    Law, J.: Risk and benefit associated with radiation dose in breast screening programmes. Br. J. Radiol. 68, 870–876 (1995)CrossRefGoogle Scholar
  17. 17.
    Preston, D.L., Mattson, A., Holmberg, E., et al.: Radiation effects on breast cancer risk: a pooled analysis of eight cohorts. Radiat. Res. 158, 220–235 (2002)CrossRefGoogle Scholar
  18. 18.
    European Commission (1996) ASQRAD—assessment system for the quantification of radiation detriment (EUR 16644, CEPN-L95/2)Google Scholar
  19. 19.
    Young, K.C., Faulkner, K., Wall, B., et al.: Review of radiation risk in breast screening. NHSBSP report no. 54 (2003)Google Scholar
  20. 20.
  21. 21.
    Department of Health Health Survey for England. Available at http://www.dh.gov. uk/PublicationsAndStatistics/PublishedSurvey/HealthSurveyForEngland/fs/e n
  22. 22.
    Johnston, K., Brown, J., Gerard, K., et al.: Valuing temporary and chronic health states associated with breast screening. Soc. Sci. Med. 47, 213–222 (1998)CrossRefGoogle Scholar
  23. 23.
    NICE Social Value Judgements report. Available at http://www.nice.org.uk/page.aspx?o=svjguidance
  24. 24.
    Fenwick, E., Byford, S.: A guide to cost-effectiveness acceptability curves. Br. J. Psychiatr. 187, 106–108 (2005)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Richard P. A. Norman
    • 1
    • 2
  • D. Gareth Evans
    • 3
    • 4
  • Douglas F. Easton
    • 5
  • Kenneth C. Young
    • 6
  1. 1.Centre for Health Economic Research and Evaluation (CHERE)University of Technology SydneyBroadway, SydneyAustralia
  2. 2.Centre for Health Sciences Barts and the London Queen Mary’s School of Medicine and DentistryWhitechapel, LondonUK
  3. 3.Breast Cancer Family History Clinic, Nightingale Centre, Withington HospitalSouth Manchester University Hospital TrustManchesterUK
  4. 4.Academic Unit of Medical Genetics and Regional Genetics ServiceSt. Mary’s HospitalManchesterUK
  5. 5.Cancer Research UK Genetic Epidemiology UnitUniversity of Cambridge, Strangeways Research LaboratoryCambridgeUK
  6. 6.National Co-ordination Centre for the Physics of MammographyRoyal Surrey County Hospital NHS TrustGuildfordUK

Personalised recommendations