Clinical for proposed intervention Following a 2006 MSAC assessment, breast MRI was conditionally recommended for use as an additional test in the diagnosis of breast cancer in asymptomatic women with a high risk of developing breast cancer when used as part of organised surveillance. Since February 2009, breast MRI has been available on the MBS as an interim funded item. The 2006 assessment also assessed breast MRI as a replacement to CBE, mammography ± ultrasound, however this was not recommended by MSAC at the time and is not being considered here. What is being assessed is: use of breast MRI for the screening of high risk women in addition to an organised surveillance program, as recommended by MSAC in 2007 (MSAC 2006). As such no change is being proposed to the use of breast MRI in the clinical pathway from what was recommended in this review;and the inclusion of additional high risk patient populations in MBS item 63464. The change in the proposed patient population will see additional patients screened who would not previously have had access to this item. This inclusion of the additional high risk patient populations are consistent with those risk factors that have been identified by the NBOCC 2009 associated with a strong Relative Risk (RR >4) increased risk of breast cancer.
In term of women who have been treated with therapeutic radiation, the Faculty of Radiation Oncology (2010) estimates that there may be at most, 1000 additional women who would be considered at high risk as a result of receiving chest irradiation for Hodgkin’s Lymphoma and therefore potentially eligible for screening with MRI. There would also be additional women who had received radiation to the chest area for conditions such as sarcoma - though this is likely to be a smaller population than those with Hodgkin’s Lymphoma. Table 4: List of resources to be considered in the economic analysis (this may be expanded upon in the subsequent review) Provider of resource Setting in which resource is provided Proportion of patients receiving resource Number of of resource per relevant time horizon per patient receiving resource Disaggregated unit cost MBS Safety nets* govt budget Private health insurer Patient Total cost Resources associated with conventional screening (mammography +/- ultrasound) Weighted average costs of a medical consultation GP/other outpatient 100 Specialist Consultation Specialist Out patient 100 Mammogram Radiologist Outpatient 100 Ultrasound Resources associated with the addition of MRI to conventional screening Weighted average cost of medical consultation GP/other Outpatient 100 Specialist appointment Specialist Outpatient 100 MRI Radiologist Outpatient 100 Mammogram Radiologist Outpatient Ultrasound Radiologist Outpatient Resources associated with follow-up resources prompted by screening Surgical biopsy Specialist Outpatient 31506 $337.60 Anaesthetic costs Specialist Outpatient Fine needle aspiration biopsy Specialist Outpatient 31533 $132.70 Ultrasound guidance Specialist Outpatient 55070 $98.25 Core needle biopsy Specialist Outpatient $132.70 Stereotactic biopsy Specialist Outpatient 31545 $573.10 Specialist appointment Specialist Outpatient Resources associated with treatment Breast Surgery Specialist Inpatient Radiotherapy Specialist Inpatient/ Outpatient Chemotherapy Specialist Inpatient/ Outpatient Hormone therapy Specialist Outpatient ‐ MRI compatible needles and disposables may also need to be considered