Bettina Wulff Risør1,2,3, Nasrin Tayyari Dehbarez4,5, Jacob Fredsøe6,7, Karina Dalsgaard Sørensen6,7, Bodil Ginnerup Pedersen7,8. 1. DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark. betris@rm.dk. 2. Danish Center for Healthcare Improvements (DCHI), Aalborg University, 9220, Aalborg, Denmark. betris@rm.dk. 3. Nordic Institute of Health Economics, 8000, Aarhus C, Denmark. betris@rm.dk. 4. DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark. 5. Danish Center for Healthcare Improvements (DCHI), Aalborg University, 9220, Aalborg, Denmark. 6. Department of Molecular Medicine (MOMA), Aarhus University Hospital, 8200, Aarhus N, Denmark. 7. Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark. 8. Department of Radiology, Aarhus University Hospital, 8200, Aarhus N, Denmark.
Abstract
OBJECTIVE: This study evaluated the cost effectiveness of using Stockholm 3 (STHLM3) testing compared to the prostate-specific antigen (PSA) test in the diagnostic pathway for prostate cancer. METHODS: We created a decision tree model for PSA (current standard) and STHLM3 (new alternative). Cost effectiveness was evaluated in a hypothetical cohort of male individuals aged 50-69 years. The study applied a Danish hospital perspective with a time frame restricted to the prostate cancer diagnostic pathway, beginning with the initial PSA/STHLM3 test, and ending with biopsy and histopathological diagnosis. Estimated values from the decision-analytical model were used to calculate the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the base-case analysis. RESULTS: The model-based analysis revealed that STHLM3 testing was more effective than the PSA, but also more costly, with an incremental cost-effectiveness ratio of €511.7 (95% credible interval, 359.9-674.3) for each additional correctly classified individual. In the deterministic sensitivity analysis, variations in the cost of STHLM3 had the greatest influence on the incremental cost-effectiveness ratio. In the probabilistic sensitivity analysis, all iterations were positioned in the north-east quadrant of the incremental cost-effectiveness scatterplot. At a willingness to pay of €700 for an additional correctly classified individual, STHLM3 had a 100% probability of being cost effective. CONCLUSIONS: Compared to the PSA test as the initial testing modality in the prostate cancer diagnostic workup, STHLM3 testing showed improved incremental effectiveness, however, at additional costs. The results were sensitive to the cost of the STHLM3 test; therefore, a lower cost of the STHLM3 test would improve its cost effectiveness compared with PSA tests.
OBJECTIVE: This study evaluated the cost effectiveness of using Stockholm 3 (STHLM3) testing compared to the prostate-specific antigen (PSA) test in the diagnostic pathway for prostate cancer. METHODS: We created a decision tree model for PSA (current standard) and STHLM3 (new alternative). Cost effectiveness was evaluated in a hypothetical cohort of male individuals aged 50-69 years. The study applied a Danish hospital perspective with a time frame restricted to the prostate cancer diagnostic pathway, beginning with the initial PSA/STHLM3 test, and ending with biopsy and histopathological diagnosis. Estimated values from the decision-analytical model were used to calculate the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the base-case analysis. RESULTS: The model-based analysis revealed that STHLM3 testing was more effective than the PSA, but also more costly, with an incremental cost-effectiveness ratio of €511.7 (95% credible interval, 359.9-674.3) for each additional correctly classified individual. In the deterministic sensitivity analysis, variations in the cost of STHLM3 had the greatest influence on the incremental cost-effectiveness ratio. In the probabilistic sensitivity analysis, all iterations were positioned in the north-east quadrant of the incremental cost-effectiveness scatterplot. At a willingness to pay of €700 for an additional correctly classified individual, STHLM3 had a 100% probability of being cost effective. CONCLUSIONS: Compared to the PSA test as the initial testing modality in the prostate cancer diagnostic workup, STHLM3 testing showed improved incremental effectiveness, however, at additional costs. The results were sensitive to the cost of the STHLM3 test; therefore, a lower cost of the STHLM3 test would improve its cost effectiveness compared with PSA tests.
Authors: M Minhaj Siddiqui; Soroush Rais-Bahrami; Baris Turkbey; Arvin K George; Jason Rothwax; Nabeel Shakir; Chinonyerem Okoro; Dima Raskolnikov; Howard L Parnes; W Marston Linehan; Maria J Merino; Richard M Simon; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: JAMA Date: 2015-01-27 Impact factor: 56.272
Authors: Olivier Wegelin; Harm H E van Melick; Lotty Hooft; J L H Ruud Bosch; Hans B Reitsma; Jelle O Barentsz; Diederik M Somford Journal: Eur Urol Date: 2016-08-25 Impact factor: 20.096
Authors: Baris Turkbey; Anna M Brown; Sandeep Sankineni; Bradford J Wood; Peter A Pinto; Peter L Choyke Journal: CA Cancer J Clin Date: 2015-11-23 Impact factor: 508.702
Authors: Fritz H Schröder; Jonas Hugosson; Monique J Roobol; Teuvo L J Tammela; Marco Zappa; Vera Nelen; Maciej Kwiatkowski; Marcos Lujan; Liisa Määttänen; Hans Lilja; Louis J Denis; Franz Recker; Alvaro Paez; Chris H Bangma; Sigrid Carlsson; Donella Puliti; Arnauld Villers; Xavier Rebillard; Matti Hakama; Ulf-Hakan Stenman; Paula Kujala; Kimmo Taari; Gunnar Aus; Andreas Huber; Theo H van der Kwast; Ron H N van Schaik; Harry J de Koning; Sue M Moss; Anssi Auvinen Journal: Lancet Date: 2014-08-06 Impact factor: 79.321
Authors: Henrik Grönberg; Martin Eklund; Wolfgang Picker; Markus Aly; Fredrik Jäderling; Jan Adolfsson; Martin Landquist; Erik Skaaheim Haug; Peter Ström; Stefan Carlsson; Tobias Nordström Journal: Eur Urol Date: 2018-07-09 Impact factor: 20.096
Authors: Henrik Grönberg; Jan Adolfsson; Markus Aly; Tobias Nordström; Peter Wiklund; Yvonne Brandberg; James Thompson; Fredrik Wiklund; Johan Lindberg; Mark Clements; Lars Egevad; Martin Eklund Journal: Lancet Oncol Date: 2015-11-10 Impact factor: 41.316
Authors: Morgan R Pokorny; Maarten de Rooij; Earl Duncan; Fritz H Schröder; Robert Parkinson; Jelle O Barentsz; Leslie C Thompson Journal: Eur Urol Date: 2014-03-14 Impact factor: 20.096
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