PURPOSE: To evaluate the clinical effectiveness and cost-effectiveness of screening strategies in which MR imaging and screen-film mammography were used, alone and in combination, in women with BRCA1 mutations. MATERIALS AND METHODS: Because this study did not involve primary data collection from individual patients, institutional review board approval was not needed. By using a simulation model, we compared three annual screening strategies for a cohort of 25-year-old BRCA1 mutation carriers, as follows: (a) screen-film mammography, (b) MR imaging, and (c) combined MR imaging and screen-film mammography (combined screening). The model was used to estimate quality-adjusted life-years (QALYs) and lifetime costs. Incremental cost-effectiveness ratios were calculated. Input parameters were obtained from the medical literature, existing databases, and calibration. Costs (2007 U.S. dollars) and quality-of-life adjustments were derived from Medicare reimbursement rates and the medical literature. Sensitivity analysis was performed to evaluate the effect of uncertainty in parameter estimates on model results. RESULTS: In the base-case analysis, annual combined screening was most effective (44.62 QALYs), and had the highest cost ($110973), followed by annual MR imaging alone (44.50 QALYs, $108641), and annual mammography alone (44.46 QALYs, $100336). Adding annual MR imaging to annual mammographic screening cost $69125 for each additional QALY gained. Sensitivity analysis indicated that, when the screening MR imaging cost increased to $960 (base case, $577), or breast cancer risk by age 70 years decreased below 58% (base case, 65%), or the sensitivity of combined screening decreased below 76% (base case, 94%), the cost of adding MR imaging to mammography exceeded $100000 per QALY. CONCLUSION: Annual combined screening provides the greatest life expectancy and is likely cost-effective when the value placed on gaining an additional QALY is in the range of $50000-$100000. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1. (c) RSNA, 2010
PURPOSE: To evaluate the clinical effectiveness and cost-effectiveness of screening strategies in which MR imaging and screen-film mammography were used, alone and in combination, in women with BRCA1 mutations. MATERIALS AND METHODS: Because this study did not involve primary data collection from individual patients, institutional review board approval was not needed. By using a simulation model, we compared three annual screening strategies for a cohort of 25-year-old BRCA1 mutation carriers, as follows: (a) screen-film mammography, (b) MR imaging, and (c) combined MR imaging and screen-film mammography (combined screening). The model was used to estimate quality-adjusted life-years (QALYs) and lifetime costs. Incremental cost-effectiveness ratios were calculated. Input parameters were obtained from the medical literature, existing databases, and calibration. Costs (2007 U.S. dollars) and quality-of-life adjustments were derived from Medicare reimbursement rates and the medical literature. Sensitivity analysis was performed to evaluate the effect of uncertainty in parameter estimates on model results. RESULTS: In the base-case analysis, annual combined screening was most effective (44.62 QALYs), and had the highest cost ($110973), followed by annual MR imaging alone (44.50 QALYs, $108641), and annual mammography alone (44.46 QALYs, $100336). Adding annual MR imaging to annual mammographic screening cost $69125 for each additional QALY gained. Sensitivity analysis indicated that, when the screening MR imaging cost increased to $960 (base case, $577), or breast cancer risk by age 70 years decreased below 58% (base case, 65%), or the sensitivity of combined screening decreased below 76% (base case, 94%), the cost of adding MR imaging to mammography exceeded $100000 per QALY. CONCLUSION: Annual combined screening provides the greatest life expectancy and is likely cost-effective when the value placed on gaining an additional QALY is in the range of $50000-$100000. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1. (c) RSNA, 2010
Authors: Nicky H G M Peters; Inne H M Borel Rinkes; Nicolaas P A Zuithoff; Willem P T M Mali; Karel G M Moons; Petra H M Peeters Journal: Radiology Date: 2007-11-16 Impact factor: 11.105
Authors: D Ford; D F Easton; M Stratton; S Narod; D Goldgar; P Devilee; D T Bishop; B Weber; G Lenoir; J Chang-Claude; H Sobol; M D Teare; J Struewing; A Arason; S Scherneck; J Peto; T R Rebbeck; P Tonin; S Neuhausen; R Barkardottir; J Eyfjord; H Lynch; B A Ponder; S A Gayther; M Zelada-Hedman Journal: Am J Hum Genet Date: 1998-03 Impact factor: 11.025
Authors: Noah D Kauff; Jaya M Satagopan; Mark E Robson; Lauren Scheuer; Martee Hensley; Clifford A Hudis; Nathan A Ellis; Jeff Boyd; Patrick I Borgen; Richard R Barakat; Larry Norton; Mercedes Castiel; Khedoudja Nafa; Kenneth Offit Journal: N Engl J Med Date: 2002-05-20 Impact factor: 91.245
Authors: Gordon F Schwartz; Kevin S Hughes; Henry T Lynch; Carol J Fabian; Ian S Fentiman; Mark E Robson; Susan M Domchek; Lynn C Hartmann; Roland Holland; David J Winchester Journal: Cancer Date: 2008-11-15 Impact factor: 6.860
Authors: L J Hamilton; A J Evans; A R M Wilson; N Scott; E J Cornford; S E Pinder; H N Khan; R D Macmillan Journal: Clin Radiol Date: 2004-10 Impact factor: 2.350
Authors: Madeleine Tilanus-Linthorst; Leon Verhoog; Inge-Marie Obdeijn; Karina Bartels; Marian Menke-Pluymers; Alexander Eggermont; Jan Klijn; Hanne Meijers-Heijboer; Theo van der Kwast; Cecile Brekelmans Journal: Int J Cancer Date: 2002-11-01 Impact factor: 7.396
Authors: Janie M Lee; Daniel B Kopans; Pamela M McMahon; Elkan F Halpern; Paula D Ryan; Milton C Weinstein; G Scott Gazelle Journal: Radiology Date: 2008-03 Impact factor: 11.105
Authors: Kathryn P Lowry; Janie M Lee; Chung Y Kong; Pamela M McMahon; Michael E Gilmore; Jessica E Cott Chubiz; Etta D Pisano; Constantine Gatsonis; Paula D Ryan; Elissa M Ozanne; G Scott Gazelle Journal: Cancer Date: 2011-09-20 Impact factor: 6.860
Authors: Yaojen Chang; Aimee M Near; Karin M Butler; Amanda Hoeffken; Sandra L Edwards; Antoinette M Stroup; Wendy Kohlmann; Amanda Gammon; Saundra S Buys; Marc D Schwartz; Beth N Peshkin; Anita Y Kinney; Jeanne S Mandelblatt; Yaojen Chang; Aimee M Near; Karin M Butler; Amanda Hoeffken; Sandra L Edwards; Antoinette M Stroup; Wendy Kohlmann; Amanda Gammon; Saundra S Buys; Marc D Schwartz; Beth N Peshkin; Anita Y Kinney; Jeanne S Mandelblatt Journal: J Oncol Pract Date: 2016-01 Impact factor: 3.840
Authors: Benjamin Zendejas; James P Moriarty; Jamie O'Byrne; Amy C Degnim; David R Farley; Judy C Boughey Journal: J Clin Oncol Date: 2011-06-20 Impact factor: 44.544
Authors: Jessica E Cott Chubiz; Janie M Lee; Michael E Gilmore; Chung Y Kong; Kathryn P Lowry; Elkan F Halpern; Pamela M McMahon; Paula D Ryan; G Scott Gazelle Journal: Cancer Date: 2012-11-26 Impact factor: 6.860