Cost-effectiveness of Biennial Breast Screening in Women With Dense Breasts: Exploratory Analysis of Pathways Incorporating an Emerging Blood RNA Test.

BACKGROUND: Emerging blood-based tests have potential to complement current breast imaging to increase early-stage detection for women with dense breasts. This analysis examines the cost-effectiveness of potential pathways using preliminary data from an emerging blood test to inform future research. MATERIALS AND METHODS: Preliminary accuracy results for the blood test were modeled in combination, and in comparison, with mammography for biennial screening starting at age 40 for women with dense breasts using a lifetime Markov model. Costs, life years (LYs) and quality-adjusted life-years (QALYs) of each screening pathway were compared. The primary results were probabilistic incremental cost-effectiveness ratios (ICER). RESULTS: Modeling showed the blood test generating 22.40 LYs, 18.78 QALYs per individual, and lifetime costs of $21,642. Combination of blood test and mammography produced higher LYs, QALYs, and costs comparatively (22.42 LYs, 18.80 QALYs, $24,986), resulting in an ICER of $169,384 per QALY compared to blood test alone. Two-way sensitivity analysis showed positive net monetary value for a range of blood test sensitivities and specificities. CONCLUSIONS: The blood test may represent a cost-effective option relative to mammography alone or in combination for biennial screening of women with dense breasts, supporting the rationale for continued evidence generation.