Excerpt

Recent evidence has suggested that MRI screening increases the sensitivity of breast cancer screening at the expense of specificity. This additional sensitivity has the potential to identify cases sooner which ought to lead to more promising prognoses. Furthermore, a hastening of a correct identification can prevent disutility associated with false negatives prior to their eventual diagnosis. Similarly, evidence has suggested that the sensitivity of the mammography options is partially compromised in younger groups, due to breast tissue density issues. The benefit of MRI screening has to be contrasted between different groups of women, and then compared with the cost implications that MRI screening has, both in the screening programme (such as the cost of those incorrectly brought back for further investigation) and in the wider National Health Service.

The primary question that this investigation is looking to answer is whether MRI screening can be recommended on clinical and cost-effectiveness grounds in particular populations of women.

Contents

• 1. Introduction
• 2. Recommendations
• 3. Evidence statements
  • 3.1 Responsibility and support for guideline development
• 4. Clinical Effectiveness of MRI
  • 4.1 Methods
  • 4.2 MRI Evidence
  • 4.3 Digital mammography Vs film mammography Evidence
• 5. Cost-Utility Analysis
  • 5.1 Executive Summary
  • 5.2 Methodology
  • 5.3 Results
  • 5.4 Discussion
• References
• Appendices
  • Appendix 1 Assumed distributions and parameters used in Probabilistic Sensitivity Analysis
  • Appendix 2 Sensitivity of Mammography by Age
  • Appendix 3 Unit costs
  • Appendix 4 Utility Multipliers Used in the Model A
  • Appendix 5 ICER’s on the cost-effectiveness plane for the six population groups
  • Appendix 6 Univariate Sensitivity Analysis Strategy and Detailed Results
  • Appendix 7 Probabilistic Sensitivity Analysis
  • Appendix 8 Clinical effectiveness evidence tables