Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Breast. 2019 Jun;45:82-88. doi: 10.1016/j.breast.2019.03.004. Epub 2019 Mar 12.
This study aimed to investigate the cost-effectiveness of intensified breast cancer (BC) screening for women with a BRCA1/2 mutation aged 60-74. Simulated strategies were: (0) annual mammography as reference, (1) alternating annual mammography and MRI for women with dense breasts only; (2) addition of annual MRI for women with dense breasts only; (3) addition of annual MRI for all women.
A validated micro-simulation model of invasive BC was updated and validated for interval BC rates and tumor size distribution. Incremental cost-effectiveness ratios (ICER) of all three intensified strategies were compared to the next best strategy and stratified for BRCA1 and BRCA2. Discount rates for costs and life years gained (LYG) were 1.5% and 4% for the Dutch situation; 3% and 3% for international comparison. A threshold of €20,000 per LYG was applied.
All intensified strategies showed more detected BCs and LYG, reduced BC deaths, and increased false positives. The Dutch discounted ICER of intensified strategy 1 compared to annual mammography was €38,000 per LYG in BRCA1 mutation carriers and €18,000 per LYG in BRCA2 mutation carriers. Further intensified strategies showed an ICER above the threshold when compared to this strategy. With international discount rate, the ICERs of all intensified strategies were above the threshold.
Of the three alternative strategies, only alternating annual MRI and mammography for BRCA2 mutation carriers and dense breasts aged 60-75 is cost-effective compared to annual mammography. For BRCA1 mutation carriers, none of the alternative strategies is cost-effective compared to the next best strategy.
本研究旨在探讨对 60-74 岁携带 BRCA1/2 突变的女性进行强化乳腺癌（BC）筛查的成本效益。模拟的策略如下：（0）以每年乳房 X 光检查作为参考，（1）对于致密乳腺的女性，交替进行每年的乳房 X 光检查和 MRI；（2）对于致密乳腺的女性，增加每年的 MRI；（3）对于所有女性，增加每年的 MRI。
对一种经过验证的浸润性 BC 微观模拟模型进行了更新和验证，以用于间隔性 BC 发生率和肿瘤大小分布。比较了所有三种强化策略的增量成本效益比（ICER），并根据 BRCA1 和 BRCA2 进行分层。对于荷兰情况，成本和获得的生命年（LYG）的贴现率为 1.5%和 4%；对于国际比较，贴现率为 3%和 3%。应用了 20,000 欧元/LYG 的阈值。
所有强化策略均显示出更多的 BC 检出和 LYG，降低了 BC 死亡率，并增加了假阳性。与每年乳房 X 光检查相比，BRCA1 突变携带者的荷兰贴现 ICER 为每年强化策略 1 每 LYG 38,000 欧元，BRCA2 突变携带者为每 LYG 18,000 欧元。与该策略相比，进一步强化的策略显示出 ICER 高于阈值。在国际贴现率下，所有强化策略的 ICER 均高于阈值。
在这三种替代策略中，只有 BRCA2 突变携带者和 60-75 岁致密乳腺的每年交替 MRI 和乳房 X 光检查策略相对于每年乳房 X 光检查具有成本效益。对于 BRCA1 突变携带者，与最佳策略相比，没有一种替代策略具有成本效益。
