Cost‐effectiveness of a new urinary biomarker‐based risk score compared to standard of care in prostate cancer diagnostics – a decision analytical model

Dijkstra, S.; Govers, Tim M.; Hendriks, Rianne J.; Schalken, Jack A.; Criekinge, Wim Van; Neste, Leander Van; Grutters, Janneke P.C.; Sedelaar, J.P. Michiel; Oort, Inge M. van

doi:10.1111/bju.13861

Cited by 49 publications

(90 citation statements)

References 22 publications

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“…The novel diagnostic strategies that were compared to PSA-based testing alone included PSA plus Prostate Health Index (PHI) testing (18,27,31), SelectMDx testing (21,24) and Urinary Proteome Analysis (UPA-PC) testing (19). The de nitions of these biomarker tests are given in Appendix 3, Table 1.…”

Section: Strategies Compared -Biomarkersmentioning

confidence: 99%

“…The modelled prevalence of prostate cancer varied from 10.9% (18) to 66.7% (31), but was usually between 24-30%. Several studies reported the percentage of prostate cancers assumed to be high grade or signi cant (24) (33) (18,21), ranging from 26%(18) to 51.2% (24).…”

Section: Patient Populationmentioning

confidence: 99%

“…The percentage of high-grade men allocated to a radical treatment (prostatectomy, radiotherapy, brachytherapy, hormone therapy or androgen deprivation therapy) varied from 65% (29) to 100% (22). The percentage of men with low grade cancer allocated to a radical treatment varied from 20% (24,29) to 100% (25). Of the other eight studies, three did not include treatment in their timeframe (17)(18)(19), four stated that individual treatments were modelled but did not give the allocation ratio (20,23,27,30), and one stated that they did not explicitly model individual treatments (31).…”

Section: Treatment Typesmentioning

confidence: 99%

“…As detailed in Table 4, all but two studies assigned disutilities to various aspects associated with testing including screening attendance, the biopsy procedure, diagnosis of cancer, treatment, active surveillance, advanced or metastatic cancer, post-treatment or recovery, adverse events associated with biopsy and treatment and palliative therapy. Five of the fourteen studies (17,21,22,24,26,27)…”

Section: Quality Of Lifementioning

confidence: 99%

“…Ten studies included costs of complications arising from biopsy (16-18, 21-26, 30). Only six studies explicitly stated that costs associated with complications arising from treatment were included (16,21,23,24,26,30).…”

Section: Resource Usementioning

confidence: 99%

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Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

Keeney

Thom

Turner

et al. 2020

Preprint

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Background There is currently no formal prostate cancer screening programme in the UK. Early detection using age-based prostate-specific antigen (PSA) testing is unlikely to be cost-effective due to limited mortality benefit and harms associated with overdetection. However, the discovery of new prostate cancer specific biomarkers and more accurate diagnostic strategies (e.g. magnetic resonance imaging (MRI)) could improve the outcomes of screening. A systematic review was conducted to assess the evidence base on cost-effectiveness of such innovations and areas for further development. Methods To identify model-based economic evaluations of screening and diagnostic tests for prostate cancer, a systematic review of the literature using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2019. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions and the results narratively synthesized. Results Sixteen studies were included in the review. Seven studies compared the cost-effectiveness of new urinary or blood biomarkers compared to each other or the PSA test and found the biomarkers e.g. the Prostate Health Index (PHI) and SelectMDx, to be the most cost-effective. Seven studies compared newer prostate biopsy methods, including MRI-guided, to TRUS guided biopsy and found MRI-guided methods to be most cost-effective. The newer detection methods showed a reduction in unnecessary biopsies and overtreatment. However, there was uncertainty around the most cost-effective pathway of follow-up strategies (MRI/biomarkers) in men who have a negative initial biopsy. Many studies did not model stage or grade of cancer, cancer progression or the entire testing, screening and treatment pathway. Very few studies fully accounted for uncertainty in their analysis. Conclusions This review brings together the cost-effectiveness literature for novel screening and testing methods used in the diagnosis of prostate cancer. Several limitations of the published models were identified. The models generally either compared new biomarkers or new imaging techniques which highlights the importance of future work in this area, as biomarkers and imaging are likely to be used in combination.

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Section: Strategies Compared -Biomarkersmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

Section: Treatment Typesmentioning

confidence: 99%

Section: Quality Of Lifementioning

confidence: 99%

Section: Resource Usementioning

confidence: 99%

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Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

Keeney

Thom

Turner

et al. 2020

Preprint

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Economic evaluation of prostate cancer risk assessment methods: A cost‐effectiveness analysis using population data

Mohammadi,

Guh,

Tam

et al. 2023

Cancer Medicine

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BackgroundThe current prostate cancer (PCa) screening standard of care (SOC) leads to unnecessary biopsies and overtreatment because decisions are guided by prostate‐specific antigen (PSA) levels, which have low specificity in the gray zone (3–10 ng/mL). New risk assessment tools (RATs) aim to improve biopsy decision‐making. We constructed a modeling framework to assess new RATs in men with gray zone PSA from the British Columbia healthcare system's perspective.MethodsWe evaluated the cost‐effectiveness of a new RAT used in biopsy‐naïve men aged 50+ with a PSA of 3–10 ng/mL using a time‐dependent state‐transition model. The model was informed by engaging patient partners and using linked administrative health data, supplemented with published literature. The incremental cost‐effectiveness ratio and the probability of the RAT being cost‐effective were calculated. Probabilistic analysis was used to assess parameter uncertainty.ResultsIn the base case, a RAT based on an existing biomarker's characteristics was a dominant strategy associated with a cost savings of $44 and a quality‐adjusted life years (QALY) gain of 0.00253 over 18 years of follow‐up. At a cost‐effectiveness threshold of $50,000/QALY, the probability that using a RAT is cost‐effective relative to the SOC was 73%. Outcomes were sensitive to RAT costs and accuracy, especially the detection rate of high‐grade PCa. Results were also impacted by PCa prevalence and assumptions about undetected PCa survival.ConclusionsOur findings showed that a more accurate RAT to guide biopsy can be cost‐effective. Our proposed general model can be used to analyze the cost‐effectiveness of any novel RAT.

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Validation of a 2‐gene mRNA urine test for the detection of ≥GG2 prostate cancer in an opportunistic screening population

et al. 2020

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Background: A 2-gene urine-based molecular test that targets messenger RNAs known to be overexpressed in aggressive prostate cancer (PCa) has been described as a helpful method for detecting clinically significant prostate cancer (grade group [GG] ≥2). We performed an external validation of this test in men undergoing initial prostate biopsy (Bx) within a Spanish opportunistic screening scenario. Methods:We analyzed archived samples from 492 men who underwent prostate Bx in an opportunistic screening scenario, with prostate-specific antigen (PSA) 3 to 10 ng/mL and/or suspicious digital rectal exploration (DRE) and without previous multi-parametric magnetic resonance imaging (mpMRI). Urinary biomarker measurements were combined with clinical risk factors to determine a risk score, and accuracy for GG ≥ 2 PCa detection was compared with PCA3, European randomized screening in prostate cancer (ERSPC), and prostate biopsy collaborative group (PBCG) risk calculators in a validation workup that included calibration, discrimination, and clinical utility analysis.Results: In our cohort, the detection rates for GG1 and GG ≥ 2 PCa were 20.3% and 14.0%, respectively. The median PSA level was 3.9 ng/mL and 13.4% of subjects had suspicious DRE findings. The median risk score for men with GG ≥ 2 PCa was 21 (interquartile range: 14-28), significantly higher than benign+GG1 PCa (10, 6-18), P < .001, achieving the highest area under the curve among the models tested, 0.749 (95% confidence interval: 0.690-0.807). The urine test was well-calibrated, while ERSPC showed a slight underestimation and PBCG a slight overestimation of risk.Assuming a GG2 non-detection rate of 11% without using mpMRI, use of the urinary biomarker-based clinical model could have helped avoid 37.2% of excess biopsies Jose Rubio-Briones and Ángel Borque-Fernando contributed equally to this study. SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section. How to cite this article: Rubio-Briones J, Borque-Fernando A, Esteban LM, et al. Validation of a 2-gene mRNA urine test for the detection of ≥GG2 prostate cancer in an opportunistic screening population. The Prostate. 2020;80:500-507.

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Cost‐effectiveness of a new urinary biomarker‐based risk score compared to standard of care in prostate cancer diagnostics – a decision analytical model

Abstract: Based on the currently available evidence, the reduction of over diagnosis and overtreatment due to the use of the SelectMDx test in men with PSA levels of >3 ng/mL may lead to a reduction in total costs per patient and a gain in QALYs.

Cited by 49 publications

References 22 publications

Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

Economic evaluation of prostate cancer risk assessment methods: A cost‐effectiveness analysis using population data

Validation of a 2‐gene mRNA urine test for the detection of ≥GG2 prostate cancer in an opportunistic screening population

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