Annual versus less frequent mammographic surveillance in people with breast cancer aged 50 years and older in the UK (Mammo-50): cost-effectiveness and budget impact analysis

Background

There is limited evidence on the optimal frequency of mammogram surveillance. At five-year follow up, the Mammo-50 trial found that, in patients aged 50+ and three years post diagnosis, less frequent mammograms were non-inferior to annual mammograms for breast-cancer-specific-survival, recurrence-free interval and overall survival.

Methods

A within-trial cost-effectiveness analysis compared annual versus less frequent mammogram surveillance over five years from healthcare and societal perspectives. Hospital Episodes Statistics captured hospital-based resource use. Health-related quality of life and other cost data were obtained via questionnaires at surveillance mammograms. A budget impact analysis estimated NHS savings.

Results

Less frequent surveillance led to cost savings of -£543.88 (-£1,116; £26) and a small reduction in quality-adjusted life years (QALYs) of -0.02 (-0.095; 0.06) per patient. The incremental net monetary benefit at a £20,000/QALY threshold was £187 (-£1,574; £2,027). Including societal costs increased savings to £1,543 per person (-£2,416; -£669), and cost-effectiveness. Projected NHS savings were £185.87 million over six years.

Conclusion

Less frequent mammogram surveillance is cost-effective. Uncertainty remains due to variability in costs and quality of life estimates, and missing data in the less frequent arm due to study design. Given the trial’s non-inferiority findings, this strategy is recommended from healthcare and societal perspectives.