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- Title
Cost-Utility of Early Breast Cancer Surveillance in Survivors of Thoracic Radiation-Treated Adolescent Hodgkin Lymphoma.
- Authors
Furzer, Jill; Tessier, Lauren; Hodgson, David; Cotton, Cecilia; Nathan, Paul C; Gupta, Sumit; Pechlivanoglou, Petros
- Abstract
<bold>Background: </bold>Adolescent women treated for Hodgkin lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children's Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25 years.<bold>Methods: </bold>A discrete event simulation model was used to simulate the life histories of a cohort of 500 000 25-year-old women treated for HL at age 15 years. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), health-care costs, and the relative cost-utility (incremental cost-utility ratio [ICUR]) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled modeling of uncertainty evaluation. A publicly funded health-care payer perspective was adopted.<bold>Results: </bold>Costs across the eight screening strategies ranged from $32 643 to $43 739, whereas QALYs ranged from 24.419 to 24.480. In an incremental cost-effectiveness analysis, annual mammography beginning at age 25 years was associated with an ICUR of $43 000/QALY gained, annual MRI beginning at age 25 years with a switch to annual mammography at age 50 years had an ICUR of $148 000/QALY, and annual MRI beginning at age 25 years had an ICUR of $227 222/QALY. Among all assessed surveillance strategies, the differences in life expectancy were small.<bold>Conclusions: </bold>Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.
- Subjects
HODGKIN'S disease; DISCRETE event simulation; MAGNETIC resonance mammography; BREAST cancer; MAGNETIC resonance imaging
- Publication
JNCI: Journal of the National Cancer Institute, 2020, Vol 112, Issue 1, p63
- ISSN
0027-8874
- Publication type
journal article
- DOI
10.1093/jnci/djz037