DataSheet_1_Cost-Effectiveness Analysis of Imaging Modalities for Breast Cancer Surveillance Among BRCA1/2 Mutation Carriers: A Systematic Review.doc

BackgroundBRCA1/2 mutation carriers are suggested with regular breast cancer surveillance screening strategies using mammography with supplementary MRI as an adjunct tool in Western countries. From a cost-effectiveness perspective, however, the benefits of screening modalities remain controversial among different mutated genes and screening schedules.MethodsWe searched the MEDLINE/PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases to collect and compare the results of different cost-effectiveness analyses. A simulated model was used to predict the impact of screening strategies in the target group on cost, life-year gained, quality-adjusted life years, and incremental cost-effectiveness ratio (ICER).ResultsNine cost-effectiveness studies were included. Combined mammography and MRI strategy is cost-effective in BRCA1 mutation carriers for the middle-aged group (age 35 to 54). BRCA2 mutation carriers are less likely to benefit from adjunct MRI screening, which implies that mammography alone would be sufficient from a cost-effectiveness perspective, regardless of dense breast cancer.ConclusionsPrecision screening strategies among BRCA1/2 mutation carriers should be conducted according to the acceptable ICER, i.e., a combination of mammography and MRI for BRCA1 mutation carriers and mammography alone for BRCA2 mutation carriers.Systematic Review RegistrationPROSPERO, identifier CRD42020205471.

背景：在西方国家，建议BRCA1/2突变携带者采用常规乳腺癌症监测筛查策略，包括乳腺摄影术，并辅以MRI作为辅助工具。然而，从成本效益的角度来看，不同突变基因和筛查方案中筛查方法的益处仍然存在争议。方法：我们检索了MEDLINE/PubMed、Embase、Cochrane图书馆、Scopus和Web of Science数据库，以收集和比较不同成本效益分析的成果。采用模拟模型预测针对目标人群的筛查策略对成本、寿命年获得、质量调整寿命年和增量成本效益比（ICER）的影响。结果：纳入了9项成本效益研究。对于中年组（35至54岁）的BRCA1突变携带者，联合乳腺摄影术和MRI策略具有成本效益。BRCA2突变携带者从辅助MRI筛查中获益的可能性较低，这表明从成本效益的角度来看，单独的乳腺摄影术就已足够，无论乳腺密度如何。结论：针对BRCA1/2突变携带者的精准筛查策略应根据可接受的ICER进行实施，即对BRCA1突变携带者采用乳腺摄影术与MRI的组合，对BRCA2突变携带者则单独使用乳腺摄影术。系统综述注册：PROSPERO，注册号CRD42020205471。