Abstract:
Recent evidence has investigated the costeffectiveness
of magnetic resonance imaging (MRI) in
younger women with a BRCA1 mutation. However,
this evidence has not been contrasted with existing
cost-effectiveness standards to determine whether
screening is appropriate, given limited societal resources.
We constructed a Markov model investigating
surveillance tools (mammography, MRI, both in parallel)
under a National Health Service (NHS) perspective.
The key benefit of MRI is that increased
sensitivity leads to early detection, and improved
prognosis. For a 30- to 39-year-old cohort, the cost per
quality-adjusted life year (QALY) of mammography
relative to no screening was £5,200. The addition of
MRI to this costs £13,486 per QALY. For a 40- to 49-
year-old cohort, the corresponding values were £2,913
and £7,781. Probabilistic sensitivity analysis supported
the cost-effectiveness of the parallel approach of
mammography and MRI. It is necessary to extend this
analysis beyond BRCA1 carriers within this age group,
and also to other age groups.
