Tollens Fabian, Baltzer Pascal A T, Dietzel Matthias, Schnitzer Moritz L, Kunz Wolfgang G, Rink Johann, Rübenthaler Johannes, Froelich Matthias F, Kaiser Clemens G
Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany.
Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Front Oncol. 2021 Sep 9;11:724543. doi: 10.3389/fonc.2021.724543. eCollection 2021.
To evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.
Decision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.
Breast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.
Based on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.
根据近期文献，评估磁共振乳腺成像（MRM）与基于X线的乳腺摄影（XM）对两年一次进行筛查的乳腺癌中度风险女性的成本效益。
采用决策分析和马尔可夫模型，比较MRM与XM在20年模型运行期内的累积成本（以美元计）和结果（以质量调整生命年计）。选择美国医疗保健系统的视角。计算增量成本效益比（ICER），并将其与每质量调整生命年100,000美元的支付意愿阈值相关联，以评估成本效益。进行确定性和概率敏感性分析，以测试输入参数变化的影响。特别是，评估了第一轮筛查后假阳性结果率的变化及其对成本效益的影响。
采用MRM进行乳腺癌筛查导致成本增加但效果更佳。确定MRM的每位女性累积平均成本为6,081美元，累积效果为15.12质量调整生命年，而采用XM筛查的成本为5,810美元，效果为15.10质量调整生命年，每获得一个质量调整生命年的ICER为13,493美元。当MRM在第二轮及后续筛查中的特异性从92%变化到99%时，每质量调整生命年的ICER在38,849美元至5,062美元之间。
根据第一轮筛查后诊断性能的最新数据，由于乳腺组织致密，MRM可能仍是筛查乳腺癌中度风险女性的经济上更优选择。
