Hodgkin's lymphoma: cost utility of breast cancer surveillance in survivors

  • Tessier L & al.
  • J Natl Cancer Inst
  • 9 May 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Annual MRI beginning at age 25 years, switching to annual mammography at age 50, is among the most cost-effective breast cancer surveillance strategies for young women who received thoracic radiotherapy (RT) for Hodgkin's lymphoma as teenagers.

Why this matters

  • American Cancer Society (ACS) guidelines (annual mammogram and MRI beginning at age 30 years) require re-evaluation because they are among the least cost-effective.

Study design

  • A discrete event simulation model was employed to simulate the life histories of a simulated cohort of 500,000 25-year-old women treated with RT at age 15 years.
  • 8 surveillance strategies evaluated.
  • Funding: None.

Key results

  • Surveillance costs ranged from $32,643 to $43,739 per person.
  • Life expectancy ranged from 45.73 to 45.90 years.
  • One of the most cost-effective strategies (annual MRI beginning at age 25 years and a switch to annual mammography at age 50) cost $38,659 and had a life expectancy of 45.86 years and cost-utility of $148,000/quality-adjusted life-year vs annual mammography starting at age 25 years.
  • The ACS strategy is among the least cost-effective; it is among the most costly ($40,932) for a life expectancy of 45.88 years and a negative cost-utility vs annual MRI beginning at age 25 years.

Limitations

  • Ductal carcinoma in situ not included.

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