■为了评估补充乳房成像方式的成本效益,在美国,女性具有异质性和极致密的乳房和平均或中等风险的乳腺癌(BC),并分析补充磁共振成像(MRI)和对比增强乳房X线照相术(CEM)的容量要求。
■补充成像方式的临床和经济结果,包括全协议和缩写协议MRI(Fp-MRI,Ab-MRI),CEM,和超声(U/S)作为X射线乳房X线照相术(XM)或数字乳房断层合成(DBT)的附加功能,与单独的XM或DBT进行比较,在与马尔可夫链链接的决策树中,通过与微观模拟分析的比较来验证。Delphi面板补充了来自文献的模型输入参数。容量模型评估了Fp-MRI和CEM所需的额外每日扫描和扫描仪的数量。
■与单独的XM或DBT相比,所有补充成像方案均符合成本效益.Fp-和Ab-MRI,在较小程度上,CEM和U/S,产生优于XM或DBT的临床结果。与XM相比,U/S和Ab-MRI的增量成本效益比(ICER)最低。对于U/S,平均风险人群的ICER为23,394美元,中等风险人群为13,241美元.对于CEM,ICER分别为38423美元和23772美元。对于具有中等风险的极其密集的亚群,可以通过每个现有的通用扫描仪每天进行一次Fp-MRI扫描来满足补充筛查要求。
■虽然超声的ICER最低,MRI和CEM显示出最好的临床结果,与单独的XM或DBT相比,女性乳房致密,中危和高危。现有的MRI扫描仪容量有可能满足该人群的大多数补充筛查需求。
UNASSIGNED: To evaluate the cost-effectiveness of supplemental breast imaging modalities for women with heterogeneously and extremely dense breasts and average or intermediate risk of breast cancer (BC) in the USA, and analyze capacity requirements for supplemental magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM).
UNASSIGNED: Clinical and economic outcomes for supplemental imaging modalities including full- and abbreviated-protocol MRI (Fp-MRI, Ab-MRI), CEM, and ultrasound (U/S) as add-on to x-ray mammography (XM) or digital breast tomosynthesis (DBT), were compared to XM or DBT alone, in a decision tree linked to a Markov chain validated by comparison with a microsimulation analysis. A Delphi panel supplemented model input parameters from the literature. A capacity model evaluated the number of additional daily scans and scanners required for Fp-MRI and CEM.
UNASSIGNED: Compared to XM or DBT alone, all supplemental imaging protocols were cost-effective. Both Fp- and Ab-MRI, and to a lesser extent CEM and U/S, yielded superior clinical outcomes to XM or DBT. Compared to XM alone, U/S and Ab-MRI had the lowest incremental cost-effectiveness ratios (ICER). For U/S, the ICER was $23,394 for the average-risk population and $13,241 for the intermediate-risk population. For CEM, the ICER was $38,423 and $23,772, respectively. For the extremely dense subpopulation with intermediate risk, supplemental screening requirements could be accommodated by conducting one Fp-MRI scan per day per existing general scanner.
UNASSIGNED: While ultrasound had the lowest ICER, MRI and CEM demonstrated the best clinical outcomes, compared to XM or DBT alone for women with dense breasts and intermediate and high risk. Existing MRI scanner capacity has the potential to meet most of the supplemental screening needs of this population.