Model of Cost-Effectiveness of MRI for Women of Average Lifetime Risk of Breast Cancer

Background: Mammography is the current standard for breast cancer detection however magnetic resonance imaging (MRI) is a more sensitive method of breast imaging. Despite MRI’s increased sensitivity, MRI has more false positives and higher costs. The purpose of this study was to determine if MRI or MRI in conjunction with mammography was a cost-effective solution for breast cancer detection in women with average lifetime risk of breast cancer. Methods: A mathematical model was used to compare annual mammography, annual MRI, and mammography and MRI on alternate years. The model included the natural history of breast cancer, screening by mammography and MRI, screening and treatment costs, and health state utilities. The Surveillance, Epidemiology, and End Results project provided data for the natural history model. Data from the Breast Cancer Surveillance Consortium and from the literature was used to model screening. Costs were taken from the Physician Fee Schedule for Medicare and Medicaid Services (CMS) and from the literature. In particular, mammograms were priced at $81.35 each and MRIs were priced at $787.23 each. Utilities for stages of breast cancer were found using Tuft University Cost Effectiveness Analysis Registry Results: The difference between MRI only and mammography only was $842,297/QALY at the standard cost of screening found from the CMS. The difference between MRI plus mammography and mammography only was $749,131/QALY at standard CMS screening costs. Discussion: Although MRI may have health benefits, at current prices, MRI screening is not a cost-effective alternative to annual mammography in women age 40 to 80 with average lifetime risk of breast cancer. MRI’s would cost effective at a $50,000 per QALY level if the cost of MRI screening were comparable to that of mammography