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Table 5 Resource modelling and cost-effectiveness results for the current and full implementation scenarios of response-guided NACT in the Netherlands

From: Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands

Cost-effectiveness analysis expressed per patient
  Current implementation (4 %) Full implementation (100 %)
Costs (€) LYs QALYs ∆ costs (€) ∆ QALYs ICER Costs (€) LYs QALYs ∆ costs (€) ∆ QALYs ICER
RG-NACT disc 28013 4.58 3.46 −13 0.005 dominanta 27698 4.64 3.58 −328 0.12 dominant
RG-NACT undisc 30362 4.79 3.62 −14 0.005 dominant 30021 4.85 3.74 −355 0.13 dominant
Conventional-NACT disc 28026 4.58 3.45 - - - 28026 4.58 3.45 - - -
Conventional-NACT undisc 30377 4.76 3.61 - - - 30377 4.76 3.61 - - -
One-way and two-way sensitivity analysis
  ICER   ICER   ICER
HR RFS HR OS HR RFS/BCSS
0.1 €-12857/QALY (cost-effective) 0.1 €1190/QALY (cost-effective) 0.1/0.1 €-922/QALY (cost-effective)
1 €2398/QALY (cost-effective) 1 €-10692/QALY (cost-effective) 1/1 €1139/QALY (cost-effective)
1.5 €9367/QALY (cost-effective) 1.5 €-15507/QALY (cost-effective) 1.5/1.5 €10299/QALY (cost-effective)
Resource modelling analysis expressed in relation to the Dutch population of ER-positive/HER2-negative breast cancer women (n = 6306)c
  Current implementation (16 hospitals, 31 MRIs) Full implementation (113 hospitals, 148 MRIs) Transition from current to full implementation
Health services required at the country level
 No of MRIs scans performed 218 5335 +5117
 No of patients scanned per MRI 7 36 +29
 Fte MRI technologists 0.2 3.8 +3.6
 Fte breast radiologists 0.02 0.4 +0.4
0.04b (↑121 %) 0.95b (↑121 %)
 No of confirmations of incidental findings (using standard imaging) 38 939 +901
Health services required at the hospital level
 No of MRIs scans performed per hospital 14 47 +33
 No of patients scanned per MRI per hospital 7 36 +29
 Fte MRI technologists per hospital 0.01 0.03 +0.02
 Fte breast radiologists per hospital 0.001 0.004 +0.003
0.002b (↑121 %) 0.001b (↑121 %)  
Health outcomes gained at the country level
 No of relapses prevented 0.4 9 +9
 No of breast cancer deaths prevented 6 149 +143
Health outcomes lost at the country level
 No of excluded patients due to contraindications 40 971 +931
 No of patients with NFS 0.07 2 +2
 Fte MRI technologists with acute transient symptom 0.04 0.9 +1
 No of patients with CHF 106 83 −23
 No of patients with long term AML/ADS 23 21 −2
 No of patients with anxiety due to incidental findings 38 939 +901
 No of patients with malignant incidental findings 8 192 +184
  1. Abbreviations: Disc discounted, undisc undiscounted, No number, Fte full-time equivalent, MRI magnetic resonance imaging, NSF nephrogenic systemic fibrosis, ATS acute transient symptom, CHF chronic heart failure, AML/ADS myelodysplastic syndrome/acute myeloid leukaemia
  2. aRG-NACT is more effective and less costly than conventional NACT
  3. bif radiologists spent 15 min to interpret 1 MRI scan
  4. cWhen possible, figures were rounded to the nearest whole number