Charu Taneja MPH, Abstract Co-Author: Research funded, Bayer AG (Berlex Inc)

John Edelsberg MD, Abstract Co-Author: Research funded, Bayer AG (Berlex Inc)

Derek Weycker PhD, Abstract Co-Author: Research funding, Bayer AG (Berlex Inc)

Amy Guo PhD, Abstract Co-Author: Research funded, Bayer AG (Berlex Inc)

Gerry Oster PhD, Abstract Co-Author: Research funded, Bayer AG (Berlex Inc)

Jeffrey C. Weinreb MD, Presenter: Consultant, General Electric Company Speakers Bureau, General Electric Company Consultant, Bayer AG (Bayer Schering Pharma AG) Speakers Bureau, Bayer AG (Bayer Schering Pharma AG) Consultant, Tyco Healthcare (Mallinckrodt Inc)

To evaluate the cost-effectiveness of MRI vs conventional x-ray mammography (XM) screening in women at high risk of BC.

We developed a model to depict outcomes and costs of MRI vs XM screening in a hypothetical cohort of 10,000 women with BRCA1/2 gene mutations or high lifetime risk of BC (collectively, “high risk”). All women were assumed to be 40 years of age, and to be screened once at model entry. Prevalence of undetected invasive BC was assumed to be 2.3%. Sensitivity and specificity of MRI (91.3% and 84.9%) and XM (24.4% and 94.1%) were estimated based on clinical trial data. The model predicts the number of women diagnosed correctly and incorrectly by each method, and consequences in terms of additional care (further diagnostic evaluation, breast cancer treatment), patient utilities, and life expectancy. Women with BC not detected at screening were assumed to be correctly diagnosed (albeit possibly at a more advanced stage) in the subsequent 12 months. Costs included those of initial screening, additional diagnostic work-up, and breast cancer treatment. Cost-effectiveness was calculated in terms of cost per quality-adjusted life-year (QALY) gained; measures of cost (2005US$) and effectiveness were discounted at 3% annually.

Among 230 women with undetected BC, 210 cases would be detected by MRI screening; only 56 would be detected with XM. MRI would yield more false-positives, however (1475 vs 576 for XM). Per-patient costs would average $2,084 for MRI and $1,154 for XM. MRI screening would produce an expected gain in life-years (22.03 vs 22.01 for XM) and QALYs (34.66 vs 34.64). Cost per QALY gained would be $42,656 ($22,933 for women with BRCA1/2 mutations, $49,150 for other high risk women).

MRI screening would result in earlier detection and treatment of invasive BC in some high-risk women at a cost acceptable by current standards of medical practice.

MRI screening for the detection of invasive BC in high-risk women especially those with BRCA1/2 mutations is cost-effective in comparison with XM.

Taneja, C, Edelsberg, J, Weycker, D, Guo, A, Oster, G, Weinreb, J, Cost-effectiveness of Magnetic Resonance Imaging (MRI) in Screening High Risk Women for Breast Cancer (BC).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011448.html