Edward C F Wilson1, Alice Wreford2, Priya Tamer3, Kelly Leonard3, Hannah Brechka3, Vincent J Gnanapragasam3,4,5. 1. Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK. edwilson@phmr.com. 2. Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK. 3. Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK. 4. Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK. 5. Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK.
Abstract
BACKGROUND: Biopsy of the prostate for suspected cancer is usually performed transrectally under local anaesthesia in the outpatient clinic setting. As this involves piercing the bowel wall, the procedure is associated with a risk of infection. Recently, devices that facilitate transperineal biopsy approaches have been developed that avoid piercing the bowel and so should reduce the risk of infection. OBJECTIVE: The aim of this study was to estimate the cost effectiveness of transperineal versus transrectal ultrasound-guided local anaesthesia procedures for prostate biopsy from the perspective of the UK NHS and to estimate the value of further research in the area. METHODS: a) Decision tree and Markov model synthesising all relevant evidence estimating the life-time costs and QALYs accrued from each biopsy mode. b) Value of information analysis to predict the return from further research and thus guide future research efforts. RESULTS: Transperineal biopsy yields an ICER below £20,000 per QALY gained at a per-procedure device acquisition cost below £81, or £41 for cost-neutrality. These results are driven by differences in consumables cost, reduced cost of treating infections, and QALY gains associated with reduced infections. There is value in future research on the diagnostic accuracy of transperineal versus transrectal biopsies and the incidence of iatrogenic infection and sepsis; consideration should be given to enriching the patient population with men with intermediate-risk disease. CONCLUSIONS: Transperineal biopsy devices may be cost effective compared with transrectal biopsy at per-procedure acquisition costs below £81 and cost-neutral if under £41. Future research is required to confirm or refute these findings, particularly randomised comparisons of the diagnostic accuracy and infection risks between the methods.
BACKGROUND: Biopsy of the prostate for suspected cancer is usually performed transrectally under local anaesthesia in the outpatient clinic setting. As this involves piercing the bowel wall, the procedure is associated with a risk of infection. Recently, devices that facilitate transperineal biopsy approaches have been developed that avoid piercing the bowel and so should reduce the risk of infection. OBJECTIVE: The aim of this study was to estimate the cost effectiveness of transperineal versus transrectal ultrasound-guided local anaesthesia procedures for prostate biopsy from the perspective of the UK NHS and to estimate the value of further research in the area. METHODS: a) Decision tree and Markov model synthesising all relevant evidence estimating the life-time costs and QALYs accrued from each biopsy mode. b) Value of information analysis to predict the return from further research and thus guide future research efforts. RESULTS: Transperineal biopsy yields an ICER below £20,000 per QALY gained at a per-procedure device acquisition cost below £81, or £41 for cost-neutrality. These results are driven by differences in consumables cost, reduced cost of treating infections, and QALY gains associated with reduced infections. There is value in future research on the diagnostic accuracy of transperineal versus transrectal biopsies and the incidence of iatrogenic infection and sepsis; consideration should be given to enriching the patient population with men with intermediate-risk disease. CONCLUSIONS: Transperineal biopsy devices may be cost effective compared with transrectal biopsy at per-procedure acquisition costs below £81 and cost-neutral if under £41. Future research is required to confirm or refute these findings, particularly randomised comparisons of the diagnostic accuracy and infection risks between the methods.
Authors: Timothy J Wilt; Michael K Brawer; Karen M Jones; Michael J Barry; William J Aronson; Steven Fox; Jeffrey R Gingrich; John T Wei; Patricia Gilhooly; B Mayer Grob; Imad Nsouli; Padmini Iyer; Ruben Cartagena; Glenn Snider; Claus Roehrborn; Roohollah Sharifi; William Blank; Parikshit Pandya; Gerald L Andriole; Daniel Culkin; Thomas Wheeler Journal: N Engl J Med Date: 2012-07-19 Impact factor: 91.245
Authors: Jeremy P Grummet; Mahesha Weerakoon; Sean Huang; Nathan Lawrentschuk; Mark Frydenberg; Daniel A Moon; Mary O'Reilly; Declan Murphy Journal: BJU Int Date: 2014-02-19 Impact factor: 5.588
Authors: Hashim U Ahmed; Ahmed El-Shater Bosaily; Louise C Brown; Rhian Gabe; Richard Kaplan; Mahesh K Parmar; Yolanda Collaco-Moraes; Katie Ward; Richard G Hindley; Alex Freeman; Alex P Kirkham; Robert Oldroyd; Chris Parker; Mark Emberton Journal: Lancet Date: 2017-01-20 Impact factor: 79.321
Authors: Rita Faria; Marta O Soares; Eldon Spackman; Hashim U Ahmed; Louise C Brown; Richard Kaplan; Mark Emberton; Mark J Sculpher Journal: Eur Urol Date: 2017-09-19 Impact factor: 20.096
Authors: Vincent J Gnanapragasam; Kelly Leonard; Michal Sut; Cristian Ilie; Jonathan Ord; Jacques Roux; Maria Consuelo Hart Prieto; Anne Warren; Priya Tamer Journal: J Clin Urol Date: 2020-06-12