Cost-Effectiveness of Digital Breast Tomosynthesis vs. Abbreviated Breast MRI for Screening Women with Intermediate Risk of Breast Cancer—How Low-Cost Must MRI Be?

Tollens, Fabian; Baltzer, Pascal; Dietzel, Matthias; Rübenthaler, Johannes; Froelich, Matthias F.; Kaiser, Ch.

doi:10.3390/cancers13061241

Cited by 18 publications

(23 citation statements)

References 37 publications

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“…We have previously indicated an economical benefit of MRM in screening women at intermediate risk in westernized countries with their respective WTP levels, i.e. their accepted monetary thresholds for gains in quality-adjusted life years ( 6 , 13 ). Compared to DBT, abbreviated breast MRI was cost-effective in screening women at intermediate risk, with an ICER below $ 20,807 per QALY gained ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…their accepted monetary thresholds for gains in quality-adjusted life years ( 6 , 13 ). Compared to DBT, abbreviated breast MRI was cost-effective in screening women at intermediate risk, with an ICER below $ 20,807 per QALY gained ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…To compare the diagnostic strategies XM versus MRM in a screening setting, a decision model was designed that included the diagnostic outcomes true positive, true negative, false positive and false negative ( Figure 1A ), based on previously published cost-effectiveness analyses ( 6 , 12 , 13 ).…”

Section: Methodsmentioning

confidence: 99%

“… Decision tree and Markov model, which have recently been developed and refined for this study ( 6 , 12 , 13 ). (A) Decision model that represents the diagnostic strategies x-ray based mammography (XM) versus MR-mammography (MRM), and the respective outcomes true positive, false negative, true negative and false positive, that each result in a Markov model simulation.…”

Section: Methodsmentioning

confidence: 99%

“…The economic potential of MR-based techniques in breast cancer screening has been demonstrated in various collectivesall with a favorable economic outcome compared to x-ray based techniques (6,(10)(11)(12)(13). However, the definition of valid input parameters for these model-based analyses depends on representative real-world data.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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ObjectivesTo 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.MethodsDecision 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.ResultsBreast 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.ConclusionsBased 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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New Approaches and Recommendations for Risk‐Adapted Breast Cancer Screening

Tsarouchi

Hoxhaj

Mann

2023

Magnetic Resonance Imaging

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Population‐based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false‐positive rates, particularly in high‐risk women, challenge the indiscriminate nature of population‐based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk‐adapted approach. Recent advancements in breast imaging technology, including contrast material‐enhanced mammography (CEM), ultrasound (US) (automated‐breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast‐agent free), may provide new opportunities for risk‐adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk‐adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk‐adapted breast cancer screening approach.Evidence Level1.Technical EfficacyStage 5.

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Economic potential of abbreviated breast MRI for screening women with dense breast tissue for breast cancer

et al. 2022

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Objectives Abbreviated breast MRI (AB-MRI) was introduced to reduce both examination and image reading times and to improve cost-effectiveness of breast cancer screening. The aim of this model-based economic study was to analyze the cost-effectiveness of full protocol breast MRI (FB-MRI) vs. AB-MRI in screening women with dense breast tissue for breast cancer. Methods Decision analysis and a Markov model were designed to model the cumulative costs and effects of biennial screening in terms of quality-adjusted life years (QALYs) from a US healthcare system perspective. Model input parameters for a cohort of women with dense breast tissue were adopted from recent literature. The impact of varying AB-MRI costs per examination as well as specificity on the resulting cost-effectiveness was modeled within deterministic sensitivity analyses. Results At an assumed cost per examination of $ 263 for AB-MRI (84% of the cost of a FB-MRI examination), the discounted cumulative costs of both MR-based strategies accounted comparably. Reducing the costs of AB-MRI below $ 259 (82% of the cost of a FB-MRI examination, respectively), the incremental cost-effectiveness ratio of FB-MRI exceeded the willingness to pay threshold and the AB-MRI-strategy should be considered preferable in terms of cost-effectiveness. Conclusions Our preliminary findings indicate that AB-MRI may be considered cost-effective compared to FB-MRI for screening women with dense breast tissue for breast cancer, as long as the costs per examination do not exceed 82% of the cost of a FB-MRI examination. Key Points • Cost-effectiveness of abbreviated breast MRI is affected by reductions in specificity and resulting false positive findings and increased recall rates. • Abbreviated breast MRI may be cost-effective up to a cost per examination of 82% of the cost of a full protocol examination. • Abbreviated breast MRI could be an economically preferable alternative to full protocol breast MRI in screening women with dense breast tissue.

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Cost-Effectiveness of Digital Breast Tomosynthesis vs. Abbreviated Breast MRI for Screening Women with Intermediate Risk of Breast Cancer—How Low-Cost Must MRI Be?

Cited by 18 publications

References 37 publications

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

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

New Approaches and Recommendations for Risk‐Adapted Breast Cancer Screening

Economic potential of abbreviated breast MRI for screening women with dense breast tissue for breast cancer

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