Purpose To evaluate the cost-effectiveness of multiparametric diagnostic magnetic resonance (MR) imaging examination followed by MR imaging-guided biopsy strategies in the detection of prostate cancer in biopsy-naive men presenting with clinical suspicion of cancer for the first time. Materials and Methods A decision-analysis model was created for biopsy-naive men who had been recommended for prostate biopsy on the basis of abnormal digital rectal examination results or elevated prostate-specific antigen levels (age groups: 41-50 years, 51-60 years, and 61-70 years). The following three major strategies were evaluated: (a) standard transrectal ultrasonography (US)-guided biopsy; (b) diagnostic MR imaging followed by MR imaging-targeted biopsy, with no biopsy performed if MR imaging findings were negative; and (c) diagnostic MR imaging followed by MR imaging-targeted biopsy, with a standard biopsy performed when MR imaging findings were negative. The following three MR imaging-guided biopsy strategies were further evaluated in each MR imaging category: (a) biopsy with cognitive guidance, (b) biopsy with MR imaging/US fusion guidance, and (c) in-gantry MR imaging-guided biopsy. Model parameters were derived from the literature. The primary outcome measure was net health benefit (NHB), which was measured as quality-adjusted life-years (QALYs) gained or lost by investing resources in a new strategy compared with a standard strategy at a willingness-to-pay (WTP) threshold of $50 000 per QALY gained. Probabilistic sensitivity analysis was performed by using Monte Carlo simulations. Results Noncontrast MR imaging followed by cognitively guided MR biopsy (no standard biopsy if MR imaging findings were negative) was the most cost-effective approach, yielding an additional NHB of 0.198 QALY compared with the standard biopsy approach. Noncontrast MR imaging followed by in-gantry MR imaging-guided biopsy (no standard biopsy if MR imaging findings were negative) led to the highest NHB gain of 0.251 additional QALY compared with the standard biopsy strategy. All MR imaging strategies were cost-effective in 94.05% of Monte Carlo simulations. Analysis by age groups yielded similar results. Conclusion MR imaging-guided strategies for the detection of prostate cancer were cost-effective compared with the standard biopsy strategy in a decision-analysis model. RSNA, 2017 Online supplemental material is available for this article.
Suppose that one has the freedom to adapt the observational network by choosing the times and locations of observations. Which choices would yield the best analysis of the atmospheric state or the best subsequent forecast? Here, this problem of ''adaptive observations'' is formulated as a problem in statistical design. The statistical framework provides a rigorous mathematical statement of the adaptive observations problem and indicates where the uncertainty of the current analysis, the dynamics of error evolution, the form and errors of observations, and data assimilation each enter the calculation. The statistical formulation of the problem also makes clear the importance of the optimality criteria (for instance, one might choose to minimize the total error variance in a given forecast) and identifies approximations that make calculation of optimal solutions feasible in principle. Optimal solutions are discussed and interpreted for a variety of cases. Selected approaches to the adaptive observations problem found in the literature are reviewed and interpreted from the optimal statistical design viewpoint. In addition, a numerical example, using the 40-variable model of Lorenz and Emanuel, suggests that some other proposed approaches may often be close to the optimal solution, at least in this highly idealized model.
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