Table 1 Personalization approaches, corresponding incremental cost and utility, ICER
Cluster | Study, study country | Risk factors | Personalization approach | Proposed strategy for low/high risk group | Population and comparative strategy | Effect or utility increment | Cost increment in USD | ICER (USD per QALY) |
|---|---|---|---|---|---|---|---|---|
Cluster 1: screening in general population | [12], USA | Age, breast density, family history | Screening frequency | Initial SFM at 40 years Low: 3-to-4-year interval, 50–79 years Average: biennial, 50–79 years Moderate: biennial, 40–79 years | General population, 40–79 years without screening | Not stated | Not stated | Not stated, but <$100,000 /QALY |
[16], USA | Age, breast density | Screening frequency | Low: DM, biennial, 40–79 years Moderate: DM, annual, 40–79 years | General population, 50–79 years with biennial DM | 0.03% higher utility | 20.8% higher cost ($730) | $151,560 /QALY | |
[14], USA | Breast density | Screening technology | Low: DM, biennial, 50–79 years Moderate: DM + US, biennial, 50–79 years | General population, 50–79 years with biennial DM | 0.005% higher utility | 12% higher cost ($370) | $246,000 /QALY | |
[17], USA | Breast density, age, other relative risks (1 to 4) | Screening frequency | Low: DM, triennial, 50–74 years, Average: DM, biennial, 50–74 years Moderate: DM, annual, 50–74 years | General population, 50–74 years with biennial DM | Not stated | Not stated | Not stated, but <$100,000/QALY | |
[15], USA | Age, breast density | Screening technology | Low: SFM, annual, 40+ years Moderate: DM, annual, 40+ years | General population, 40+ years with annual SFM | 0.001% higher utility | 6.0% higher cost ($139) | $69,575 /QALY | |
[13], USA | Age, breast density, family history (4 risk groups) | Screening frequency | Low: SFM, 4 years, 50–69 years Average: SFM, 4 years, 45–74 years Moderate: SFM, annual, 54–74 years | General population, 50–79 years with biennial SFM | 3.8% higher utility | 8.9% lower cost (−$124) | Dominant | |
Cluster 2: screening in high risk population | [19], Spain | Age, lifetime risk (>25%) | Screening technology and frequency | High: MRI / DM + CBE alternation, annual, 30–74 years | High risk population, 30–74 years with biennial MRI | 0.04% higher utility | 3.8% higher cost ($1379) | $59,198 /QALY |
[22], USA | Age, BRCA1/2 | Screening technology | High: MRI / DM alternation, biannual, 30+ years | BRCA population, 30+ years with annual DM | 0.2% higher utility | 10.3% higher cost ($10,239) | $70,128 /QALY (BRCA1) $203,863/QALY (BRCA2) | |
[21], USA | Age, family history (lifetime risk >15%) | Screening technology | High: MRI, annual, 25–50 years | High risk population, 25–50 years with annual SFM | 0.7% higher utility | 281% higher cost ($11,598) | $115,983 /QALY | |
[23] | BRCA1 | Screening technology | High: SFM + MRI annual, 30–49 years | BRCA population, 30–49 years, with annual SFM | 0.9% higher utility in 30–39 and 1.8% in 40–49 | 41% higher cost in 30–39 and 34% in 40–49 | $15,525 /QALY in 30–39 year olds $8987 /QALY in 40–49 year olds | |
[24], USA | BRCA1 | Screening technology | High: SFM + MRI, annual, 25–70 years | High risk population, 25–70 years with annual SFM | 0.4% higher utility | 10.6% higher cost ($9469) | $57,737 /QALY | |
[25], USA | Age, BRCA1/2 | Screening technology | High: MRI, annual, 25–29 years; MRI + SFM, annual, 30–49 years; SFM, annual, 50–75 years | High risk population, 25–79 years with annual SFM | 0.4% higher utility | 90.2% higher cost ($3484) | $38,708 /QALY | |
[20], Canada | High breast density | Screening frequency | High: SFM, annual, 50–79 years | High risk population, 50–79 years with biennial SFM | 0.01% higher utility | 42.5% higher cost ($579) | $413,571 /QALY | |
[26], Canada | Age, BRCA1/2 | Screening technology | High: MRI + SFM, annual, 35–54 years | BRCA population, 25–69 years with annual SFM | 1.1% higher utility | 21.2% higher cost ($10,626) | $45,725 /QALY (BRCA1) $107,832 /QALY (BRCA2) | |
[27], USA | Age, BRCA1/2, lifetime risk (>20%) | Screening technology | High: MRI + SFM at age 40 years | High risk population at 40 years with SFM | 0.1% higher utility | 34% higher cost ($589) | $21,189 /QALY | |
Cluster 3: screening after risk assessment | [31], USA | Gail risk classification, 7SNP | Risk assessment plus screening technology | Initial 7SNP testing Low: SFM, annual, 40–75 years High: MRI, annual, 40–75 years | General population, 40–75 years with Gail testing and the same screening strategy | 0.05% higher utility | 7.6% higher cost ($503) | $158,318 /QALY |
[29], USA | BRCA1/2, family history (lifetime risk >10%) | Risk assessment plus prophylactic surgery plus screening | Initial BRCA1/2 testing Low: no screening High: risk reduction surgery; MRI + SFM, annual, 30+ years | High risk population (Ashkenazi), 30+ years with family history based testing | 0.1% higher utility | 3.6% lower cost (−$83) | Dominant | |
[28], UK | Age, high risk (5-year Gail risk >1.67%), atypia | Risk assessment plus chemoprevention plus screening | Initial atypia testing at 40 years Low: annual SFM, 40–74 years High: tamoxifen prevention, 40–74 years | High risk population, 40–74 years with annual SFM | 0.5% higher effect | Higher costa (US $1357) | US $6463/QALY |