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

Dibenedetto

et al. 2019

In Vivo

Background/Aim: To evaluate the diagnostic accuracy of the urinary SelectMDx test in the diagnosis of clinically significant prostate cancer (csPCa) in men enrolled in an active surveillance (AS) protocol. Patients and Methods: From July 2015 to July 2018, 125 men with very low-risk PCa were enrolled in the AS protocol; all patients underwent confirmatory transperineal saturation biopsy (SPBx). In the presence of PI-RADS score ≥3, a targeted MRI/TRUS fusion-guided biopsy was added to SPBx. Postdigital rectal examination urine was collected in 45/125 (36%) patients before SPBx; the genetic urine analysis was performed using a biomarker-based risk score model, the SelectMDx, that measured mRNA levels of distal-less homeobox 1 (DLX1) and homeobox C6 (HOXC6). Results: A total of 9/45 (20%) patients were reclassified as csPCa (7 cases=Grade Group 2; 2 cases=Grade Group 3); sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of mpMRI vs. SelectMDx in the diagnosis of csPCa were equal to 66.

Section: Discussionmentioning

confidence: 99%

Multiparametric MRI Versus SelectMDx Accuracy in the Diagnosis of Clinically Significant PCa in Men Enrolled in Active Surveillance

Dibenedetto

et al. 2019

In Vivo

“…To identify the PI-RADS score at high risk for csPCa irrespective of clinical findings many parameters have been reported: index lesion diameter, shape and location of the lesion (25) and the ADC values (4,7,9). Wu et al (9) showed that higher ADC values (0.830×10 -3 mm 2 /sec) were significantly associated with low-risk prostate cancer; on the contrary, Kim et al (6) reported a mean ADC value for csPCa equal to (0.741±0.164) ×10 -3 mm 2 /sec.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy of TPBx in the diagnosis of csPCa (Gleason score>6 and/or greatest percentage of cancer for single core>50%) was evaluated (13); moreover, the Clavien-Dindo grading system for the classification of biopsy complications was used (14). Finally, the diameter of mpMRI lesion, the presence of PI-RADS score 3 vs. 4 and ADC values were evaluated in men with csPCa; in this respect, a receiver operating characteristic (ROC) curve was calculated in the peripheral mpMRI lesions to evaluate the diagnostic performance of ADC values as well as to determine the ADC cut-off level that provided the highest diagnostic performance. For statistical analysis the Student's t-test was used; a p-value <0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer

Garufi

Priolo

et al. 2019

In Vivo

“…The most influential economic study on UK prostate biopsy policy is the Faria et al [9] model, drawing on the PROMIS study [10], on which UK guidelines are largely based. Other economic studies support the use of mpMRI first line [33][34][35][36] and newer biomarker tests appear cost effective compared with a first-line biopsy [37,38]. However, comparison with mpMRI first line is unknown.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Economic Evaluation of Transperineal versus Transrectal Devices for Local Anaesthetic Prostate Biopsies

Wilson

Wreford

Tamer³

et al. 2021

PharmacoEconomics Open

Background Biopsy of the prostate for suspected cancer is usually performed transrectally under local anaesthesia in the outpatient clinic setting. As this involves piercing the bowel wall, the procedure is associated with a risk of infection. Recently, devices that facilitate transperineal biopsy approaches have been developed that avoid piercing the bowel and so should reduce the risk of infection. Objective The aim of this study was to estimate the cost effectiveness of transperineal versus transrectal ultrasound-guided local anaesthesia procedures for prostate biopsy from the perspective of the UK NHS and to estimate the value of further research in the area. Methods a) Decision tree and Markov model synthesising all relevant evidence estimating the life-time costs and QALYs accrued from each biopsy mode. b) Value of information analysis to predict the return from further research and thus guide future research efforts. Results Transperineal biopsy yields an ICER below £20,000 per QALY gained at a per-procedure device acquisition cost below £81, or £41 for cost-neutrality. These results are driven by differences in consumables cost, reduced cost of treating infections, and QALY gains associated with reduced infections. There is value in future research on the diagnostic accuracy of transperineal versus transrectal biopsies and the incidence of iatrogenic infection and sepsis; consideration should be given to enriching the patient population with men with intermediate-risk disease. Conclusions Transperineal biopsy devices may be cost effective compared with transrectal biopsy at per-procedure acquisition costs below £81 and cost-neutral if under £41. Future research is required to confirm or refute these findings, particularly randomised comparisons of the diagnostic accuracy and infection risks between the methods.