Cancer Control Research, BC Cancer Agency, 675 W, 10th Ave, Vancouver, BC V5Z 1L3, Canada.
BMC Cancer. 2013 Jul 10;13:339. doi: 10.1186/1471-2407-13-339.
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
We constructed a Markov model of annual MRI and mammography screening for BRCA1/2 carriers, using local data and published values. We calculated cost-effectiveness as cost per quality-adjusted life-year gained (QALY), and conducted one-way and probabilistic sensitivity analysis.
The incremental cost-effectiveness ratio (ICER) of annual mammography plus MRI screening, compared to annual mammography alone, was $50,900/QALY. After incorporating parameter uncertainty, MRI screening is expected to be a cost-effective option 86% of the time at a willingness-to-pay of $100,000/QALY, and 53% of the time at a willingness-to-pay of $50,000/QALY. The model is highly sensitive to the cost of MRI; as the cost is increased from $200 to $700 per scan, the ICER ranges from $37,100/QALY to $133,000/QALY.
The cost-effectiveness of using MRI and mammography in combination to screen for breast cancer in BRCA1/2 mutation carriers is finely balanced. The sensitivity of the results to the cost of the MRI screen itself warrants consideration: in jurisdictions with higher MRI costs, screening may not be a cost-effective use of resources, but improving the efficiency of MRI screening will also improve cost-effectiveness.
携带 BRCA1 或 BRCA2 基因突变的女性罹患乳腺癌的风险较高，在加拿大不列颠哥伦比亚省，为了便于早期发现，为她们提供磁共振成像（MRI）和乳房 X 线照相术联合筛查。MRI 比乳房 X 线照相术更敏感，但成本更高，且产生更多的假阳性结果。本研究旨在计算在加拿大环境下，对 BRCA1/2 突变携带者进行 MRI 乳腺癌筛查的成本效益。
我们使用当地数据和已发表的数值构建了 BRCA1/2 携带者年度 MRI 和乳房 X 线照相术筛查的 Markov 模型。我们将成本效益计算为每获得一个质量调整生命年（QALY）的成本，并进行了单因素和概率敏感性分析。
与单独进行年度乳房 X 线照相术筛查相比，每年进行乳房 X 线照相术联合 MRI 筛查的增量成本效益比（ICER）为 50900 美元/QALY。在纳入参数不确定性后，在支付意愿为 100000 美元/QALY 时，MRI 筛查预计将是一种具有成本效益的选择，占 86%的时间；在支付意愿为 50000 美元/QALY 时，占 53%的时间。该模型对 MRI 成本非常敏感；当 MRI 扫描的成本从 200 美元增加到 700 美元时，ICER 从 37100 美元/QALY 变化到 133000 美元/QALY。
使用 MRI 和乳房 X 线照相术联合筛查 BRCA1/2 突变携带者乳腺癌的成本效益平衡得非常精细。结果对 MRI 筛查本身成本的敏感性值得考虑：在 MRI 成本较高的司法管辖区，筛查可能不是资源的有效利用，但提高 MRI 筛查的效率也将提高成本效益。
