Modeled Number and Cost of Biparametric Magnetic Resonance Imaging (bpMRI) Examinations in a Nationwide Prostate Cancer Screening Program: Utilizing the Results of the Czech Prostapilot Study
Author(s)
Ondrej Majek, PhD1, Katerina Hejcmanová, MSc2, Michal Stanik, Assoc Prof3, Michal Standara, MD4, Jan Kristek, PhD4, Roman Zachoval, Prof5, Renata Chloupková, MSc2, Ondrej Ngo, PhD1, Karel Hejduk, PhDr1, Ladislav Dušek, Prof6.
1Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, 2National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic, 3Department of Urologic Oncology, Department of Surgical Oncology, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 4Department of Radiology, Masaryk Memorial Cancer Institute, Brno, Czech Republic, 5Department of Urology, 3rd Faculty of Medicine of Charles University and Faculty Thomayer Hospital, Prague, Czech Republic, 6Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
1Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, 2National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic, 3Department of Urologic Oncology, Department of Surgical Oncology, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic, 4Department of Radiology, Masaryk Memorial Cancer Institute, Brno, Czech Republic, 5Department of Urology, 3rd Faculty of Medicine of Charles University and Faculty Thomayer Hospital, Prague, Czech Republic, 6Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
OBJECTIVES: Czechia initiated nationwide prostate cancer screening programme in 2024. The pilot phase of the programme is 5 years, during which experience and evidence is gathered to reach final decision and strategy for routine screening programme. Our objective was to investigate alternative screening scenarios following the results of the Czech Prostapilot (NCT05603351) study.
METHODS: The aim of the Prostapilot study was to assess the role of bpMRI in screening for clinically significant prostate cancer (csPC). We used screening process characteristics associated with bpMRI use to estimate number and cost of bpMRI examinations and cost to detect one csPC. We previously designed a model of patient flow through the potential organised prostate cancer screening programme utilising literature and Czech national registry data. We now used data from the ongoing nationwide programme to assess the generalisability of Prostapilot results.
RESULTS: We previously estimated that approximately 310,000 men are to be enrolled in one year. Previously, we expected that with 15% PSA positivity and follow-up urological assessment and selection for bpMRI, 23,247 men would undergo bpMRI. According to Prostapilot results, 5.9% were PSA3+. If those men were directly referred to bpMRI, 18,288 of them would undergo bpMRI (4.4 million EUR) and 2,195 csPC were detected. Considering cost of PSA, bpMRI, and biopsy/pathology, cost to detect 1 csPC is 4,597 EUR. In case all men with PSA1+ (43.7%) undergo bpMRI, cost to detect 1 csPC increases to 8,144 EUR. Data from national programme are in line with Prostapilot estimates (8.8% PSA3+, 43.4% PSA1+).
CONCLUSIONS: Real-world data lead to lower estimates of PSA positivity than previously expected, likely because of high prevalence of opportunistic screening. Extended bpMRI use is therefore potentially feasible. Whereas the lower PSA threshold could alleviate limitations of PSA sensitivity, it is associated with a substantial resource consumption.[supported by the Czech Ministry of Health, NU22-09-00539]
METHODS: The aim of the Prostapilot study was to assess the role of bpMRI in screening for clinically significant prostate cancer (csPC). We used screening process characteristics associated with bpMRI use to estimate number and cost of bpMRI examinations and cost to detect one csPC. We previously designed a model of patient flow through the potential organised prostate cancer screening programme utilising literature and Czech national registry data. We now used data from the ongoing nationwide programme to assess the generalisability of Prostapilot results.
RESULTS: We previously estimated that approximately 310,000 men are to be enrolled in one year. Previously, we expected that with 15% PSA positivity and follow-up urological assessment and selection for bpMRI, 23,247 men would undergo bpMRI. According to Prostapilot results, 5.9% were PSA3+. If those men were directly referred to bpMRI, 18,288 of them would undergo bpMRI (4.4 million EUR) and 2,195 csPC were detected. Considering cost of PSA, bpMRI, and biopsy/pathology, cost to detect 1 csPC is 4,597 EUR. In case all men with PSA1+ (43.7%) undergo bpMRI, cost to detect 1 csPC increases to 8,144 EUR. Data from national programme are in line with Prostapilot estimates (8.8% PSA3+, 43.4% PSA1+).
CONCLUSIONS: Real-world data lead to lower estimates of PSA positivity than previously expected, likely because of high prevalence of opportunistic screening. Extended bpMRI use is therefore potentially feasible. Whereas the lower PSA threshold could alleviate limitations of PSA sensitivity, it is associated with a substantial resource consumption.[supported by the Czech Ministry of Health, NU22-09-00539]
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE586
Topic
Economic Evaluation, Real World Data & Information Systems
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Oncology, Urinary/Kidney Disorders