Cost-Effectiveness Analysis Reveals Optimal Screening Strategy for Prostate Cancer

Submitted by admin5 on Tue, 05/23/2017 - 14:02

A diagnostic magnetic resonance imaging (MRI) scan followed by an MRI-guided biopsy strategy is more cost-effective than an invasive transrectal ultrasound for detecting prostate cancer, according to research published in Radiology (published online May 2017; doi:10.1148/radiol.2017162181).

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Current standard of care for detecting prostate cancer incorporates 12 biopsy samples collected during an invasive transrectal ultrasound. This approach will often detect clinically insignificant tumors and miss significant ones, result in bleeding or complications, increase health care costs, or lead patients into treatment regimens with potential negative side effects. On the contrary, MRI offers a non-invasive alternative to the standard of care which has the potential to help better guide biopsy pathways, but is generally believed to come with a higher cost.

Shivani Pahwa, MD, department of radiology, Case Western Reserve University, and colleagues conducted a study to evaluate the cost-effectiveness of MRI examination followed by MRI-guided biopsy strategies in detecting prostate cancer in biopsy-naïve men with suspicion of disease. Researchers examined 3 strategies: standard transrectal ultrasonography; diagnostic MRI followed by MRI-targeted biopsy, with no biopsy performed if imaging findings were negative; and diagnostic MRI followed by MRI-targeted biopsy, with a standard biopsy performed when MRI findings were negative.

Primary outcome was net health benefit, measured as quality-adjusted life-years (QALYs) gained or lost as a result of a new strategy compared with the standard strategy at a willingness-to-pay threshold of $50,000 per QALY gained.

Researchers found MRI followed by MRI-targeted biopsy, with no biopsy performed if imaging findings were negative as the most cost-effective approach, yielding an additional net health benefit of 0.198 QALY compared with the standard strategy. Additionally, MRI was found to increase standardized QALYs for patients and was cost-effective in 94.05% of simulations.

Researchers believe that the results of their study could lead to a paradigm shift in standard prostate cancer detection methods. "Costs are escalating in part due to expensive and inefficient diagnostic pathways, and placement of patients in incorrect treatment groups. If we can maximize efficiency in how we identify clinically significant lesions and diagnose patients, we can reduce unnecessary treatments for our patients, and reduce costs to our hospitals,” said Vikas Gulani, MD, PhD, study advisor, in a statement (May 17, 2017).—Zachary Bessette