Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening.

Autor:	Tollens F; Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany., Baltzer PAT; Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Dietzel M; Department of Radiology, Friedrich-Alexander-University Hospital Erlangen, Erlangen, Germany., Schnitzer ML; Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany., Kunz WG; Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany., Rink J; Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany., Rübenthaler J; Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany., Froelich MF; Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany., Kaiser CG; Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2021 Sep 09; Vol. 11, pp. 724543. Date of Electronic Publication: 2021 Sep 09 (Print Publication: 2021).
DOI:	10.3389/fonc.2021.724543
Abstrakt:	Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Tollens, Baltzer, Dietzel, Schnitzer, Kunz, Rink, Rübenthaler, Froelich and Kaiser.)
Databáze:	MEDLINE
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