Taneja Charu, Edelsberg John, Weycker Derek, Guo Amy, Oster Gerry, Weinreb Jeffrey
Policy Analysis Inc, Brookline, Massachusetts 02445, USA.
J Am Coll Radiol. 2009 Mar;6(3):171-9. doi: 10.1016/j.jacr.2008.10.003.
The aim of this study was to estimate the cost effectiveness of breast cancer screening with contrast-enhanced magnetic resonance imaging (MRI), with and without adjunctive x-ray mammography (XM), compared with XM alone in high-risk women.
A model was developed to depict the consequences of screening with MRI and/or XM for cohorts of 10,000 women with BRCA1/2 mutations and women with other high-risk characteristics, respectively. The model predicted the number of women correctly and incorrectly diagnosed with each strategy and lifetime consequences in terms of additional care, patient utilities, life expectancy, and quality-adjusted life-years (QALYs). Cost effectiveness was calculated in terms of cost per QALY gained.
Among the 400 women (of 10,000) with BRCA1/2 mutations and undiagnosed breast cancer, 361 cases would be detected with MRI and XM, 290 with MRI, and 160 with XM. False-positive results would total 1,526, 1,190, and 528, respectively. Cost per QALY gained with MRI and XM compared with XM alone for women with BRCA1/2 mutations was $25,277. Among other high-risk women, cost per QALY gained with MRI and XM compared with XM alone varied depending on the prevalence of breast cancer, ranging from $45,566 (300 cases) to $310,616 (50 cases). The cost effectiveness of MRI alone compared with XM alone was similar.
Screening with MRI, alone or in combination with XM, in women with BRCA1/2 mutations is cost effective by current standards compared with XM alone. In women with other high-risk characteristics, MRI screening may also be cost effective, depending on the expected prevalence of undiagnosed breast cancer at the time of screening.
本研究旨在评估在高危女性中，对比增强磁共振成像（MRI）联合或不联合乳腺X线摄影（XM）进行乳腺癌筛查与单纯XM筛查相比的成本效益。
建立了一个模型，分别描述对10000名携带BRCA1/2突变的女性队列和具有其他高危特征的女性队列进行MRI和/或XM筛查的结果。该模型预测了每种筛查策略正确和错误诊断的女性人数，以及在额外护理、患者效用、预期寿命和质量调整生命年（QALY）方面的终生后果。成本效益通过每获得一个QALY的成本来计算。
在10000名携带BRCA1/2突变且未诊断出乳腺癌的女性中，MRI联合XM可检测出361例，MRI单独检测出290例，XM单独检测出160例。假阳性结果分别为1526例、1190例和528例。对于携带BRCA1/2突变的女性，MRI联合XM与单纯XM相比，每获得一个QALY的成本为25277美元。在其他高危女性中，MRI联合XM与单纯XM相比，每获得一个QALY的成本因乳腺癌患病率而异，范围从45566美元（300例）到310616美元（50例）。MRI单独筛查与XM单独筛查的成本效益相似。
按照当前标准，在携带BRCA1/2突变的女性中，MRI单独或联合XM筛查与单纯XM筛查相比具有成本效益。在具有其他高危特征的女性中，MRI筛查也可能具有成本效益，这取决于筛查时未诊断乳腺癌的预期患病率。
