Cost-Effectiveness of Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study

Dec 1, 2021, 00:00
10.1016/j.jval.2021.06.001
https://www.valueinhealthjournal.com/article/S1098-3015(21)01587-4/fulltext
Title : Cost-Effectiveness of Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(21)01587-4&doi=10.1016/j.jval.2021.06.001
First page : 1763
Section Title : ECONOMIC EVALUATION
Open access? : Yes
Section Order : 1763

Objective

This study aimed to assess the cost-effectiveness of magnetic resonance imaging (MRI) with combinations of targeted biopsy (TBx) and systematic biopsy (SBx) for early prostate cancer detection in Sweden.

Methods

A cost-utility analysis was conducted from a lifetime societal perspective using a microsimulation model. Five strategies included no screening and quadrennial screening for men aged 55 to 69 years using SBx alone, TBx on positive MRI (MRI + TBx), combined TBx/SBx on positive MRI (MRI + TBx/SBx), and SBx on negative MRI with TBx/SBx on positive MRI (MRI − SBx, MRI + TBx/SBx). Test characteristics were based on a recent Cochrane review. We predicted the number of biopsies, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios.

Results

The screening strategies were classified in Sweden as high costs per QALY gained compared with no screening. Using MRI + TBx and MRI + TBx/SBx reduced the number of biopsy episodes across a lifetime by approximately 40% compared with SBx alone. Both strategies showed strong dominance over SBx alone and MRI − SBx, MRI + TBx. Compared with MRI + TBx, the MRI + TBx/SBx strategy had an incremental cost-effectiveness ratio of more than €200 000 per QALY gained, which was classified in Sweden as a very high cost. These predictions were robust in the probabilistic sensitivity analysis. Limitations included generalizability of the model assumptions and uncertainty regarding the health-state values and study heterogeneity from the Cochrane review.

Conclusions

MRI + TBx and MRI + TBx/SBx showed strong dominance over alternative screening strategies. MRI + TBx resulted in similar or marginally lower gains in QALYs and lower costs than MRI + TBx/SBx. MRI + TBx was considered the optimal choice among the screening strategies.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Diagnostics & Imaging
  • Economic Evaluation
  • Medical Technologies
  • Methodological & Statistical Research
  • Modeling and simulation
  • Oncology
  • Specific Diseases & Conditions
Tags :
  • biopsy
  • cost-effectiveness
  • magnetic resonance imaging
  • microsimulation
  • prostate cancer
  • screening
  • Sweden
Regions :
  • Western Europe
ViH Article Tags :