To determine how best to use MRI and targeted MR/ultrasound fusion biopsy for early detection of prostate cancer in men with elevated PSA and whether it can be cost-effective.
A Markov model of prostate cancer onset and progression was developed to estimate health and economic consequences of prostate cancer screening with MRI. Men were screened with prostate-specific antigen (PSA) from ages 55 to 69. Men with elevated PSA (>4 ng/mL) received an MRI, followed by targeted fusion or combined (standard + targeted fusion) biopsy on positive MRI, and standard or no biopsy on negative MRI. Prostate imaging reporting and data system (PI-RADS) score on MRI determined biopsy decisions. Deaths averted, quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratio (ICER) were estimated for each strategy.
With a negative MRI, standard biopsy was more expensive and had lower QALYs than performing no biopsy. The optimal screening strategy (ICER: $23,483/QALY) recommended combined biopsy for men with PI-RADS score ≥3 and no biopsy for men with PI-RADS score <3, and reduced the number of screening biopsies by 15%. Threshold analysis suggests MRI continues to be cost-effective when sensitivity and specificity of MRI and combined biopsy are simultaneously reduced by 19.0.
Our analysis suggests MRI followed by targeted MR/ultrasound fusion biopsy can be a cost-effective approach for early detection of prostate cancer. This article is protected by copyright. All rights reserved.
BJU international. 2018 Feb 01 [Epub ahead of print]
Christine L Barnett, Matthew S Davenport, Jeffrey S Montgomery, John T Wei, James E Montie, Brian T Denton
Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, 48109, USA., Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA., Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA.