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. 2022 Nov;32(11):7409-7419.
doi: 10.1007/s00330-022-08777-5. Epub 2022 Apr 28.

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

Fabian Tollens  1 , Pascal A T Baltzer  2 , Matthias Dietzel  3 , Moritz L Schnitzer  4 , Vincent Schwarze  4 , Wolfgang G Kunz  4 , Johann Rink  1 , Johannes Rübenthaler  4 , Matthias F Froelich  1 , Stefan O Schönberg  1 , Clemens G Kaiser  5
Affiliations

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

Fabian Tollens et al. Eur Radiol. 2022 Nov.

Abstract

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.

Keywords: Breast neoplasms; Cost-effectiveness analysis; Magnetic resonance imaging; Mammography; Screening.

PubMed Disclaimer

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
a Decision-tree including the four screening strategies and the corresponding outcomes true positive, false negative, true negative, and false positive. b Markov model with Markov states and their corresponding quality of life (QOL). The likelihood of detecting a breast tumor in two-yearly screening depends on the sensitivity of the screening method. Death is possible at any state. The Markov model has been published recently and refined for this analysis and patient collective [15, 17]. AB-MRI, abbreviated breast magnetic resonance imaging; DBT, digital breast tomosynthesis; FB-MRI, full protocol breast magnetic resonance mammography; QOL, quality of life; XM, x-ray mammography
Fig. 2
Fig. 2
Cost-effectiveness graph for the screening strategies. Varying costs per examination of abbreviated breast MRI (AB-MRI) from US-$ 220 to US-$ 314 were assumed, which equals the cost of a full protocol breast MRI (FB-MRI). MR-based screening modalities result in higher effectiveness compared to x-ray-based modalities, but also higher average costs. AB-MRI, abbreviated breast magnetic resonance imaging; DBT, digital breast tomosynthesis; FB-MRI, full protocol breast magnetic resonance mammography; QALY, quality-adjusted life year; XM, x-ray mammography
Fig. 3
Fig. 3
One-way sensitivity analysis for varying costs per examination of abbreviated breast MRI (AB-MRI). The resulting incremental cost-effectiveness ratio (ICER) of full protocol breast MRI (FB-MRI) compared to AB-MRI is indicated for varying specificities of FB-MRI (a) and varying specificities of AB-MRI (b). For a specificity of 92%, FB-MRI is cost-saving if the cost per examination of AB-MRI is larger than $ 263 (threshold 1). The ICER of FB-MRI is below a willingness to pay threshold of $100,000 per QALY if the cost per examination of AB-MRI is between $ 259 and $ 263 (threshold 2), indicating AB-MRI to be cost-effective below $ 259. AB-MRI, abbreviated breast magnetic resonance imaging; FB-MRI, full protocol breast magnetic resonance mammography; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year
Fig. 4
Fig. 4
Two-way sensitivity analysis of the net monetary benefit for varying cost per examination and varying specificity of abbreviated breast MRI (AB-MRI). The color-coded area indicates the dominant strategy at a given cost and specificity of AB-MRI. The smaller the cost and the higher the specificity of AB-MRI, the more likely it ought to be preferred to full protocol breast MRI (FB-MRI). AB-MRI, abbreviated breast magnetic resonance imaging; FB-MRI, full protocol breast magnetic resonance mammography
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