Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany.
Department of Radiology, Friedrich-Alexander-University Hospital Erlangen, Germany.
Eur J Radiol. 2021 Mar;136:109355. doi: 10.1016/j.ejrad.2020.109355. Epub 2020 Oct 16.
The aim of this study was to analyze the cost-effectiveness of screening patients of intermediate risk of breast cancer with MR-Mammography (MRM) versus conventional mammography (XM).
A decision model for both diagnostic modalities and a subsequent markov model for the simulation of follow-up costs and outcomes was developed. Input parameters were acquired from published literature for this markov modelling study. The expected cumulative costs and outcomes were calculated for both modalities in a 30-year timeframe in US-dollar ($) and quality-adjusted life years (QALYs). A deterministic sensitivity analysis and a probabilistic sensitivity analysis incorporating 30,000 Monte Carlo iterations were performed to investigate the model stability.
In total, XM with its consecutive treatments resulted in total costs of $ 5,492.68 and an average cumulative quality of life of 18.87 QALYs, compared to MRM with costs of $ 5,878.66 and 18.92 QALYs. The corresponding incremental cost-effectiveness ratio (ICER) for MRM was $ 8,797.60 per QALY - distinctly below international willingness-to-pay thresholds for cost-effectiveness. The results were confirmed within the limits of the sensitivity analyses.
In patients with intermediate risk for breast cancer due to their dense breast tissue, two-yearly screening with MRM may be considered as cost-effective.
本研究旨在分析使用磁共振乳腺成像（MRM）与传统乳腺 X 线摄影（XM）对中等乳腺癌风险患者进行筛查的成本效益。
为两种诊断方式建立了决策模型，并随后建立了马尔可夫模型来模拟随访成本和结果。这项马尔可夫建模研究的输入参数来自已发表的文献。在 30 年的时间内，以美元（$）和质量调整生命年（QALYs）为单位，计算了两种方式的预期累计成本和结果。进行了确定性敏感性分析和包含 30,000 次蒙特卡罗迭代的概率敏感性分析，以研究模型的稳定性。
总的来说，与 XM 及其后续治疗相比，MRM 的总费用为$5492.68，平均累积生活质量为 18.87 QALYs；而 XM 的费用为$5878.66，累积生活质量为 18.92 QALYs。MRM 的增量成本效益比（ICER）为每 QALY$8797.60，明显低于国际成本效益意愿支付阈值。敏感性分析也证实了这一结果。
对于由于致密乳腺组织而处于中等乳腺癌风险的患者，每两年进行一次 MRM 筛查可能被认为是具有成本效益的。
