23 148
Platinum Priority
–
Prostate Cancer
Editorial by Jochen Walz on pp. 31
–
32 of this issue
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)
Rita Faria
a , * , Marta O. Soares a , Eldon Spackman b , Hashim U. Ahmed c , g , Louise C. Brown d , ** ,Richard Kaplan
d , Mark Emberton e , f , Mark J. Sculpher aa
Centre for Health Economics, University of York, York, UK;
b
University of Calgary, Alberta, Canada;
c
Imperial Urology
—
Division of Surgery, Imperial College
London, London, UK;
d
Medical Research Council Clinical Trials Unit at University College London, London, UK;
e
Division of Surgery and Interventional
Science, Faculty of Medical Sciences, University College London, London, UK;
f
Department of Urology, University College London Hospitals NHS Foundation
Trust, London, UK;
g
Imperial Urology, Imperial College Healthcare NHS Trust
E U R O P E A N U R O L O GY 7 3 ( 2 0 18 ) 2 3 – 3 0ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comArticle info
Article history:
Accepted August 16, 2017
Associate Editor:
Giacomo Novara
Keywords:
Prostate cancer
Cost-effectiveness analysis
Magnetic resonance imaging
Prostate biopsy
Model-based analysis
Abstract
Background:
The current recommendation of using transrectal ultrasound-guided bi-
opsy (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 de
fi
nitions
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
fi
rst and then up to two MRI-targeted TRUSBs
detects more CS cancers per pound spent than a strategy using TRUSB
fi
rst (sensitivity =
0.95 [95% con
fi
dence interval {CI} 0.92
–
0.98] vs 0.91 [95% CI 0.86
–
0.94]) and is cost
effective (ICER = £7,076 [
s
8350/QALY gained]). The limitations stem from the evidence
base in the accuracy of MRI-targeted biopsy and the long-term outcomes of menwith CS
prostate cancer.
Conclusions:
An MPMRI-
fi
rst strategy is effective and cost effective for the diagnosis of
CS prostate cancer. These
fi
ndings 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.
* Corresponding author. Centre for Health Economics, University of York, Heslington, York YO10
5DD, UK. Tel. +44 (0)1904 32 14 35; Fax: +44 1904 321402.
E-mail address:
rita.nevesdefaria@york.ac.uk(R. Faria).
** Corresponding author. Medical Research Council Clinical Trials Unit at University College London,
London, UK.
E-mail address:
l.brown@ucl.ac.uk(L.C. Brown).
http://dx.doi.org/10.1016/j.eururo.2017.08.0180302-2838/© 2017 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC BY
license
( http://creativecommons.org/licenses/by/4.0/ ).