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PURPOSE: Observational series have suggested that adding annual whole breast ultrasound (US) to mammographic screening improves detection of early stage cancers, particularly for women with mammographically dense breasts. We performed a value of information analysis to determine if further study of screening breast ultrasound is necessary prior to implementing this strategy.
METHODS: We constructed a Markov model from a societal perspective comparing screening with mammography plus US to mammography alone for women with mammographically dense breasts and 25% lifetime risk of breast cancer. We determined the value of perfect information by calculating the average difference between the expected net economic benefit given perfect information on all model variables and the expected net economic benefit given current data in 5,000 Monte Carlo simulations at cost-effectiveness thresholds ranging from zero to $100,000 per quality adjusted life year (QALY). In addition to perfect information on all model variables, we also independently assessed the value of information on the effectiveness of US, cost of US, quality of life measures, efficacy of mammography and disease related variables. We assumed that 520,000 women would meet our criteria for US screening over the next 10 years.
RESULTS: In the base case, the addition of US to mammography improved quality adjusted life expectancy by 0.056 QALYs at an incremental cost effectiveness ratio (ICER) of $38,000 per QALY. The maximum value of simultaneous, perfect information on all variables was $375 per person, or $176 million for the eligible population. Considered individually, the incremental efficacy of US had a maximum value of $121 million, perfect information on the cost of US and on utilities each had a value of $98 million. Value of information decreases as cost-effectiveness thresholds exceed the ICER. At $100,000 per QALY perfect information has an expected value of $24 million.
CONCLUSIONS: Screening breast US may improve the lives of eligible women, but its cost-effectiveness is uncertain. Further research would decrease this uncertainty and has a maximum expected value of $176 million dollars. This value is concentrated in three areas, the incremental efficacy of US, the cost of US and women’s utilities for breast cancer related health states. Further research on these topics should be undertaken before a decision is made on adding US to a breast cancer screening regimen.
See more of Oral Concurrent Session B - Screening in Chronic Disease
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)