Cost-effectiveness of Multiparametric MRI in 800 Men Submitted to Repeat Prostate Biopsy: Results of a Public Health Model.

BACKGROUND/AIM To evaluate the cost-effectiveness of multiparametric magnetic imaging resonance (mpMRI) in men submitted to repeat saturation prostate biopsy (SPBx). MATERIALS AND METHODS From January 2011 to June 2017, 800 men underwent repeat SPBx; the cost-effectiveness of mpMRI if used as a 'triage test' to avoid unnecessary repeat prostate biopsy was retrospectively calculated using the Italian Public National Health System Day Service. RESULTS SPBx vs. MRI fusion targeted biopsy diagnosed 215 (89.5%) vs. 184 (76.6%) out of 240, respectively. The overall cost of the 800 prostate biopsies was 138,221 €; the use of mpMRI as triage test would have spared 364/800 procedures, equivalent to 60,905 € (44% of the entire cost), whilst missing 15/205 (7.3%) cases of clinically significant cancer. CONCLUSION mpMRI used as a triage test could reduce the need for prostate biopsies by about 45%, thereby improving cost-effectiveness, however, patients should be informed of the false-negative rate associated with mpMRI.

[1]  A. Dwivedi,et al.  Prebiopsy multiparametric MRI‐based risk score for predicting prostate cancer in biopsy‐naive men with prostate‐specific antigen between 4–10 ng/mL , 2018, Journal of magnetic resonance imaging : JMRI.

[2]  Marta O. Soares,et al.  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) , 2018, European urology.

[3]  P. Pepe,et al.  Multiparametric MRI/TRUS Fusion Prostate Biopsy: Advantages of a Transperineal Approach. , 2017, Anticancer research.

[4]  Vikas Gulani,et al.  Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men. , 2017, Radiology.

[5]  Alan D. Lopez,et al.  Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study , 2017, JAMA oncology.

[6]  V. Laudone,et al.  The Efficacy of Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Risk Classification for Patients with Prostate Cancer on Active Surveillance. , 2016, The Journal of urology.

[7]  H. Ahmed,et al.  The Prevalence of Clinically Significant Prostate Cancer According to Commonly Used Histological Thresholds in Men Undergoing Template Prostate Mapping Biopsies. , 2016, The Journal of urology.

[8]  Shyam Natarajan,et al.  Prostate cancer detection with magnetic resonance‐ultrasound fusion biopsy: The role of systematic and targeted biopsies , 2016, Cancer.

[9]  F. Bladou,et al.  Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer. , 2016, Urologic oncology.

[10]  Antonio Garufi,et al.  Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance? , 2016, World Journal of Urology.

[11]  C. Roehrborn,et al.  Decision analysis model comparing cost of multiparametric magnetic resonance imaging vs. repeat biopsy for detection of prostate cancer in men with prior negative findings on biopsy. , 2015, Urologic oncology.

[12]  T. Tammela,et al.  Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up , 2014, The Lancet.

[13]  Maarten de Rooij,et al.  Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective. , 2014, European urology.

[14]  M. Roethke,et al.  Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla , 2014, European Radiology.

[15]  C Fraser,et al.  The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. , 2013, Health technology assessment.

[16]  Chris Metcalfe,et al.  Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study , 2012, BMJ : British Medical Journal.

[17]  Eric J Feuer,et al.  Projections of the cost of cancer care in the United States: 2010-2020. , 2011, Journal of the National Cancer Institute.

[18]  J. Coebergh,et al.  Bowel, urinary, and sexual problems among long-term prostate cancer survivors: a population-based study. , 2009, International journal of radiation oncology, biology, physics.

[19]  P. Malone,et al.  Prostate , 1995 .