Cost-Utility of Early Breast Cancer Surveillance in Survivors of Thoracic Radiation-Treated Adolescent Hodgkin Lymphoma

Abstract

Background Adolescent women treated for Hodgkin lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children’s Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25 years. Methods A discrete event simulation model was used to simulate the life histories of a cohort of 500 000 25-year-old women treated for HL at age 15 years. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), health-care costs, and the relative cost-utility (incremental cost-utility ratio [ICUR]) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled modeling of uncertainty evaluation. A publicly funded health-care payer perspective was adopted. Results Costs across the eight screening strategies ranged from $32 643 to $43 739, whereas QALYs ranged from 24.419 to 24.480. In an incremental cost-effectiveness analysis, annual mammography beginning at age 25 years was associated with an ICUR of $43 000/QALY gained, annual MRI beginning at age 25 years with a switch to annual mammography at age 50 years had an ICUR of $148 000/QALY, and annual MRI beginning at age 25 years had an ICUR of $227 222/QALY. Among all assessed surveillance strategies, the differences in life expectancy were small. Conclusions Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.

Integration of Pediatric Hodgkin Lymphoma Treatment and Late Effects Guidelines: Seeing the Forest Beyond the Trees

“…To overcome these challenges, researchers have used simulation modeling to evaluate the clinical effectiveness and cost-effectiveness of endorsed strategies. 46,[49][50][51] Despite being limited in scope (radiation-related breast cancer, 46,52,53 colorectal cancer, 54 anthracycline-related cardiomyopathy [49][50][51] ), these efforts have facilitated the refinement and often the deintensification of recommended screening frequencies. 46,[49][50][51] Notably, they have paved the way for much-needed efforts to evaluate existing screening recommendations across a broader set of health outcomes and to assess multilevel interventions seeking to reduce the burden of morbidity in survivors.…”

The Cost-Effectiveness of Mammography-Based Breast Cancer Screening in Canada

“…While this population was highly specific, it still fell within the scope of this review. 21 Furzer et al found that annual mammography-based breast cancer screening beginning at age 25 was associated with an ICER of $43,000/QALY, while a switch to annual MRI starting at age 50 had an ICER of $148,000/QALY. 21 Lastly, screening using annual MRI starting from age 25 had an ICER of $227,222/QALY.…”

“…21 Furzer et al found that annual mammography-based breast cancer screening beginning at age 25 was associated with an ICER of $43,000/QALY, while a switch to annual MRI starting at age 50 had an ICER of $148,000/QALY. 21 Lastly, screening using annual MRI starting from age 25 had an ICER of $227,222/QALY. 21 However, despite large differences in ICERs, the life expectancy between the various surveillance methods had very little variation, as it ranged from 45.73 years (for annual mammography starting at age 30 years) to 45.90 years for (annual mammography and MRI starting at age 25 years).…”

Subsequent Primary Neoplasms

“…Simulation, using Markov health states is currently being used to address cost-effectiveness of breast cancer screening recommendations. 143…”