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?

Fabian Tollens; Pascal A T Baltzer; Matthias Dietzel; Johannes Rübenthaler; Matthias F Froelich; Clemens G Kaiser

doi:10.3390/cancers13061241

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?

Cancers (Basel). 2021 Mar 12;13(6):1241. doi: 10.3390/cancers13061241.

Authors

Fabian Tollens¹, Pascal A T Baltzer², Matthias Dietzel³, Johannes Rübenthaler⁴, Matthias F Froelich¹, Clemens G Kaiser¹

Affiliations

¹ Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
² Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, 1090 Wien, Austria.
³ Department of Radiology, Friedrich-Alexander-University Hospital Erlangen, 91054 Erlangen, Germany.
⁴ Department of Radiology, Ludwig-Maximilians-University Munich, 80331 München, Germany.

Abstract

Background: Digital breast tomosynthesis (DBT) and abbreviated breast MRI (AB-MRI) offer superior diagnostic performance compared to conventional mammography in screening women with intermediate risk of breast cancer due to dense breast tissue. The aim of this model-based economic evaluation was to analyze whether AB-MRI is cost-effective in this cohort compared to DBT.

Methods: Decision analysis and Markov simulations were used to model the cumulative costs and quality-adjusted life-years (QALYs) over a time horizon of 30 years. Model input parameters were adopted from recent literature. Deterministic and probabilistic sensitivity analyses were applied to test the stability of the model.

Results: In the base-case scenario, the costs of an AB-MRI examination were defined to equal the costs of a full protocol acquisition. Two-yearly screening of women with dense breasts resulted in cumulative discounted costs of $8798 and $9505 for DBT and AB-MRI, and cumulative discounted effects of 19.23 and 19.27 QALYs, respectively, with an incremental cost-effectiveness ratio of $20,807 per QALY gained in the base-case scenario. By reducing the cost of an AB-MRI examination below a threshold of $241 in sensitivity analyses, AB-MRI would become cost-saving compared to DBT.

Conclusion: In comparison to DBT, AB-MRI can be considered cost-effective up to a price per examination of $593 in screening patients at intermediate risk of breast cancer.

Keywords: AB-MRI; MR-Mammography; breast cancer; cost-effectiveness analyses; cost-effectiveness threshold; intermediate-risk screening; tomosynthesis.