Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS).

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Title: Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS).
Author(s): Faria, R
Soares, MO
Spackman, E
Ahmed, HU
Brown, LC
Kaplan, R
Emberton, M
Sculpher, MJ
Item Type: Journal Article
Abstract: BACKGROUND: The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI). OBJECTIVE: To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS). INTERVENTION: Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs. RESULTS AND LIMITATIONS: The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92-0.98] vs 0.91 [95% CI 0.86-0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer. CONCLUSIONS: An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines. PATIENT SUMMARY: We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money.
Publication Date: 19-Sep-2017
Date of Acceptance: 16-Aug-2017
URI: http://hdl.handle.net/10044/1/51714
DOI: https://dx.doi.org/10.1016/j.eururo.2017.08.018
ISSN: 0302-2838
Publisher: Elsevier
Start Page: 23
End Page: 30
Journal / Book Title: European Urology
Volume: 73
Issue: 1
Copyright Statement: © 2017 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC BY
Sponsor/Funder: Wellcome Trust
Funder's Grant Number: 204998/Z/16/Z
Keywords: Cost-effectiveness analysis
Magnetic resonance imaging
Model-based analysis
Prostate biopsy
Prostate cancer
Cost-effectiveness analysis
Magnetic resonance imaging
Model-based analysis
Prostate biopsy
Prostate cancer
1103 Clinical Sciences
Urology & Nephrology
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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