Janie M. Lee

Annual Screening Strategies in BRCA1 and BRCA2 Gene Mutation Carriers: A Comparative Effectiveness Analysis

Although breast cancer screening with mammography and magnetic resonance imaging (MRI) is recommended for breast cancer‐susceptibility gene (BRCA) mutation carriers, there is no current consensus on the optimal screening regimen.

Cost-effectiveness of Breast MR Imaging and Screen-Film Mammography for Screening BRCA1 Gene Mutation Carriers

PURPOSEnTo 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.nnnMATERIALS AND METHODSnBecause 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.nnnRESULTSnIn the base-case analysis, annual combined screening was most effective (44.62 QALYs), and had the highest cost (

Breast Cancer Screening in BRCA1 Mutation Carriers: Effectiveness of MR Imaging—Markov Monte Carlo Decision Analysis

110973), followed by annual MR imaging alone (44.50 QALYs,

Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers

108641), and annual mammography alone (44.46 QALYs,

Detecting Occult Malignancy in Prophylactic Mastectomy: Preoperative MRI Versus Sentinel Lymph Node Biopsy

100336). Adding annual MR imaging to annual mammographic screening cost

Detecting Nonpalpable Recurrent Breast Cancer: The Role of Routine Mammographic Screening of Transverse Rectus Abdominis Myocutaneous Flap Reconstructions

69125 for each additional QALY gained. Sensitivity analysis indicated that, when the screening MR imaging cost increased to

Using radiation risk models in cancer screening simulations: important assumptions and effects on outcome projections.

960 (base case,

The American Cancer Society guidelines for breast screening with magnetic resonance imaging: an argument for genetic testing.

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

Auditing a Breast MRI Practice: Performance Measures for Screening and Diagnostic Breast MRI

100000 per QALY.nnnCONCLUSIONnAnnual 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

Staging MR lymphangiography of the axilla for early breast cancer:cost-effectiveness analysis

50000-