Janie M. Lee MD, Presenter: Nothing to Disclose

Daniel B. Kopans MD, Abstract Co-Author: Research support, General Electric Company

Pamela M. McMahon, Abstract Co-Author: Nothing to Disclose

Paula D. Ryan MD, Abstract Co-Author: Nothing to Disclose

Elissa M. Ozanne PhD, Abstract Co-Author: Nothing to Disclose

Elkan F. Halpern PhD, Abstract Co-Author: Research Consultant, Hologic, Inc Research Consultant, Advanced Magnetics, Inc

G. Scott Gazelle MD, MPD, PhD, Abstract Co-Author: I was paid to teach a course at Philips Electronics in January 2009

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the cost-effectiveness of MRI and mammography screening strategies for women with BRCA1 gene mutations.

Using a Markov Monte Carlo model, we compared 3 annual screening strategies versus clinical surveillance without imaging for a cohort of 25 year old BRCA1 mutation carriers: 1) Mammography, 2) MRI, 3) Combined MRI and Mammography. The model produced estimates of life expectancy (yrs), quality adjusted life expectancy (QALYs), and lifetime costs. Incremental cost-effectiveness analysis was performed to compare strategies. Input parameters were obtained from the published medical literature, existing databases, and expert opinion. Costs related to screening and diagnosis were derived from Medicare reimbursement rates. Additional costs and quality of life adjustments were derived from the published medical literature. Costs and life expectancy were discounted annually by 3%. Sensitivity analysis was performed to evaluate the effect of uncertainty in parameter estimates on results.

  In the base case analysis, annual combined MRI and mammography screening provided the greatest life expectancy (49.09 yrs) and quality-adjusted life expectancy (43.75 QALYs), but was also associated with the highest lifetime costs ($281,186), followed by annual MRI alone (48.99 yrs, 43.68 QALYs, $279,272), annual mammography alone (48.89 yrs, 43.59 QALYs, $270,071), and clinical surveillance without imaging (48.63 yrs, 43.46 QALYs, $264,153). The incremental cost-effectiveness ratio (ICER) for adding annual MRI to annual screening mammography was $55,575/life year gained, and $69,469/QALY gained. Results were sensitive to estimates of MRI cost and mutation penetrance, but otherwise stable across the specified parameter ranges. When the cost of a screening MRI examination increased to $883 (base case: $577), or the risk of breast cancer by age 70 fell below 29% (base case: 65%), the ICER exceeded $100,000/QALY.

For BRCA1 mutation carriers, combined annual MRI and mammography screening provides the greatest life expectancy gain and is likely cost-effective when compared with annual mammography alone.

For BRCA1 mutation carriers, combined annual MRI and mammography screening provides the greatest life expectancy gain and is likely cost-effective when compared with annual mamm  

Lee, J, Kopans, D, McMahon, P, Ryan, P, Ozanne, E, Halpern, E, Gazelle, G, et al, , Cost-effectiveness of Breast MRI for Screening BRCA1 Gene Mutation Carriers.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010757.html