232140 Pre-operative breast MRI and treatment outcomes: A cost-effectiveness analysis

Monday, November 8, 2010

Erica Nelson , Department of Health Policy and Management, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
Halle Amick , Department of Health Policy & Management, Gillings School of Global Public Health at UNC Chapel Hill, Chapel Hill, NC
Background: Nearly 12% of American women will be treated for invasive breast cancer during their lifetimes. Breast magnetic resonance imaging (BMRI) may improve surgical planning and outcomes. There is concern regarding treatment delay and increased rate of mastectomy in practices utilizing universal BMRI.

Objective: To assess the costs, risks, and benefits associated with universal BMRI in early stage breast cancer compared to no further imaging prior to local therapy, over five years.

Design: Decision tree model

Data Sources: Clinical trials, meta-analyses, government-sponsored research studies

Target Population: Women diagnosed with Stage I or II invasive breast cancer

Perspective: Payer

Intervention: Breast magnetic resonance imagery

Outcome Measures: Life-years saved, costs incurred Base-Case Analysis: BMRI was projected to have almost no effect on 5-year survival compared to no BMRI. The incremental cost-effectiveness ratio was $203 per life-year saved. BMRI was always more expensive and is more effective approximately half of the time.

Sensitivity Analysis: Deterministic sensitivity analyses indicated that results were most sensitive to changes in the probabilities of 5-year survival. Probabilistic sensitivity analyses showed uncertainty did not influence the conclusions of the cost-effectiveness analysis.

Limitations: Costs, risks, and benefits associated with additional BMRI findings and decreased quality of life due to unnecessary mastectomy were beyond the scope of this analysis. Neo-adjuvant therapies were not considered in the model.

Conclusions: Universal BMRI is a costly addition to pre-treatment planning and results in no significant benefits to the patient. Payers should ensure that BMRI is indicated prior to authorizing payment.

Learning Areas:
Public health or related research

Learning Objectives:
Formulate models of relationships between treatment outcomes and cost measures that incorporate qualitative information about breast cancer treatment decision-making and issues of ethics and values. Identify cost measures reflecting the payer perspective. Identify study and epidemiological data and adjust for biases and for temporal changes as needed to reflect effectiveness.

Keywords: Breast Cancer, Cost-Effectiveness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Delta Omega student nominee
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.