Cost-Effectiveness of MRI Screening in Women with Familial Breast Cancer Risk

February 2013, Vol 4, No 2 - Health Economics

San Antonio, TX—Adding magnetic resonance imaging (MRI) to a breast cancer screening strategy for women with a familial risk of cancer costs approximately 2.6 times as much per life-years gained compared with screening with mammography alone, Dutch researchers reported at the CTRC-AACR San Antonio Breast Cancer Symposium.

“Screening with MRI is most expensive in the youngest age categories, but these are also the age categories in which MRI might potentially be most useful, since breast density is often high,” according to Sepideh Saadatmand, MD, of Erasmus Medical Center in Rotterdam, the Netherlands.

MRI has been shown to improve the sensitivity of breast cancer detection and to be cost-effective for BRCA mutation carriers; however, for women with a family history without a proven genetic predisposition, the cost-effectiveness has been unclear, the investigators pointed out.

The study evaluated the cost-effectiveness of additional MRI for women with a familial risk in the large, prospective MRI Screening (MRISC) study. Investigators calculated the breast cancer incidence rate, the costs per detected and treated breast cancer, and the costs per life-years gained using data from women who were deemed to have a cumulative risk of 15% to 50% in the MRISC study. The study was conducted from 1999 to 2007, screening 1597 women (aged 25-70 years) with annual mammography plus MRI and with clinical breast examinations every 6 months.

Various screening schemes were evaluated, and the costs per life-years gained were compared with the Dutch nationwide breast cancer screening program (biennial mammography for women aged 50-75 years).

MRI Screening Costs
MRI screening detected 47 breast cancers among the 1597 women, leading to an incidence rate of 5.6 per 1000 women-years.

The cost per detected and treated cancer was €101,277 over all age categories. The costs strongly diminished as the age of the women increased, probably as a result of the higher breast cancer incidence, the researchers suggested.

The investigators calculated that screening with the MRISC study scheme (yearly mammography plus MRI and clinical breast examination every 6 months from ages 35 to 60 years) will reduce breast cancer mortality by 30%, at a cost per life-year gained of €122,208.

With yearly mammography and clinical breast examination alone (the standard Dutch approach), the estimated mortality reduction would be 21%, and the cost per life-year gained would be €47,940.

“Screening with MRI may improve survival for women with a familial risk for breast cancer, but it is expensive, especially in the younger age categories,” Dr Saadatmand concluded.

Breast density increases the incidence of breast cancer, whereas it decreases the sensitivity of mammography. Breast density, therefore, may be a key discriminator for selecting the optimal screening strategy for women with familial breast cancer risk, whether mammography or MRI, the investigators suggested.

A randomized controlled trial is needed to further elucidate the cost-effectiveness of MRI, the investigators said. In the Familial MRI Screening Study, women aged 35 to 60 years with an estimated lifetime risk of breast cancer ≥20% as a result of family history will be randomized into 2 screening groups: yearly mammography plus clinical breast examination or yearly MRI plus clinical breast examination and mammography biennially, with mammographic density as a stratification factor.