Louisa G Gordon1, Robbie James2, Haitham W Tuffaha2, Anthony Lowe3,4, John Yaxley5. 1. QIMR Berghofer Medical Research Institute, Brisbane, Australia. 2. Griffith University, Centre for Applied Health Economics, Nathan Campus, Brisbane, Australia. 3. Prostate Cancer Foundation of Australia, St Leonards, Sydney, Australia. 4. Griffith University, Menzies Health Institute Queensland, Southport, Australia. 5. The Wesley Hospital, Auchenflower, Brisbane, Australia.
Abstract
PURPOSE: To evaluate the cost-effectiveness of multiparametric magnetic resonance imaging (mpMRI) to diagnose prostate cancer and direct all low-risk patients into active surveillance (AS). MATERIALS AND METHODS: A Markov cohort model was developed to assess three scenarios: 1) no mpMRI and current AS; 2) mpMRI and current AS; and 3) mpMRI and increased AS. Men were tracked from diagnosis to end-of-life. Estimates to populate the model were derived from systematic reviews, meta-analyses, epidemiological publications, and national cost reports. An Australian Government perspective was used. Outcomes included healthcare costs, survival, quality-adjusted life years (QALYs), number of biopsies, and significant and insignificant cancers. Extensive sensitivity analyses were undertaken to address possible variation in the modeled inputs. RESULTS: Mean lifetime costs per patient were AU$23,191 for Scenario 1, AU$23,387 for Scenario 2 and AU$21,064 for Scenario 3. Corresponding QALYs were 7.81, 7.77, 7.83 for Scenarios 1, 2, and 3, respectively. At the current uptake of AS in Australia, mpMRI alone does not appear cost-effective (16.9% likelihood). However, mpMRI with AS for all men with low-risk disease is strongly cost-effective (86.9% likelihood) at a willingness-to-pay AU$50,000 per QALY gained. For the mpMRI options, for every 1000 men suspected of prostate cancer, using mpMRI would avoid 340 biopsies, detect an additional 20 significant cancers, and detect 10 fewer insignificant cancers. CONCLUSION: Diagnosis of prostate cancer through mpMRI technology would be cost-effective if it leads to increased uptake of AS for men with confirmed very-low- or low-risk prostate cancer. LEVEL OF EVIDENCE: 2 J. MAGN. RESON. IMAGING 2017;45:1304-1315.
PURPOSE: To evaluate the cost-effectiveness of multiparametric magnetic resonance imaging (mpMRI) to diagnose prostate cancer and direct all low-risk patients into active surveillance (AS). MATERIALS AND METHODS: A Markov cohort model was developed to assess three scenarios: 1) no mpMRI and current AS; 2) mpMRI and current AS; and 3) mpMRI and increased AS. Men were tracked from diagnosis to end-of-life. Estimates to populate the model were derived from systematic reviews, meta-analyses, epidemiological publications, and national cost reports. An Australian Government perspective was used. Outcomes included healthcare costs, survival, quality-adjusted life years (QALYs), number of biopsies, and significant and insignificant cancers. Extensive sensitivity analyses were undertaken to address possible variation in the modeled inputs. RESULTS: Mean lifetime costs per patient were AU$23,191 for Scenario 1, AU$23,387 for Scenario 2 and AU$21,064 for Scenario 3. Corresponding QALYs were 7.81, 7.77, 7.83 for Scenarios 1, 2, and 3, respectively. At the current uptake of AS in Australia, mpMRI alone does not appear cost-effective (16.9% likelihood). However, mpMRI with AS for all men with low-risk disease is strongly cost-effective (86.9% likelihood) at a willingness-to-pay AU$50,000 per QALY gained. For the mpMRI options, for every 1000 men suspected of prostate cancer, using mpMRI would avoid 340 biopsies, detect an additional 20 significant cancers, and detect 10 fewer insignificant cancers. CONCLUSION: Diagnosis of prostate cancer through mpMRI technology would be cost-effective if it leads to increased uptake of AS for men with confirmed very-low- or low-risk prostate cancer. LEVEL OF EVIDENCE: 2 J. MAGN. RESON. IMAGING 2017;45:1304-1315.
Authors: Matthew J Roberts; Alastair Macdonald; Sachinka Ranasinghe; Harrison Bennett; Patrick E Teloken; Patrick Harris; David Paterson; Geoff Coughlin; Nigel Dunglison; Rachel Esler; Robert A Gardiner; Thomas Elliott; Louisa Gordon; John Yaxley Journal: Prostate Cancer Prostatic Dis Date: 2020-08-05 Impact factor: 5.554
Authors: Alexandre Cavalcante; Públio Cesar C Viana; Giuliano B Guglielmetti; José Pontes Junior; Henrique Nonemacher; Mauricio D Cordeiro; Regis Otaviano F Bezerra; Rafael F Coelho; William Carlos Nahas Journal: Clinics (Sao Paulo) Date: 2018-12-10 Impact factor: 2.365