Economic evaluation of the introduction of the Prostate Health Index as a rule-out test to avoid unnecessary biopsies in men with prostate specific antigen levels of 4-10 in Hong Kong

Abstract

A recent study showed that the Prostate Health Index may avoid unnecessary biopsies in men with prostate specific antigen 4-10ng/ml and normal digital rectal examination in the diagnosis of prostate cancer in Hong Kong. This study aimed to conduct an economic evaluation of the impact of adopting this commercially-available test in the Hong Kong public health service to determine whether further research is justified. A cost-consequence analysis was undertaken comparing the current diagnostic pathway with a proposed diagnostic pathway using the Prostate Health Index. Data for the model was taken from a prospective cohort study recruited at a single-institution and micro-costing studies. Using a cut off PHI score of 35 to avoid biopsy would cost HK$3,000 and save HK$7,988 per patient in biopsy costs and HK$511 from a reduction in biopsy-related adverse events. The net cost impact of the change was estimated to be HK$5,500 under base case assumptions. At the base case sensitivity and specificity for all grades of cancer (61.3% and 77.5% respectively) all grade cancer could be missed in 4.22% of the population and high grade cancer in 0.53%. The introduction of the prostate health index into the diagnostic pathway for prostate cancer in Hong Kong has the potential to reduce biopsies, biopsy costs and biopsy-related adverse events. Policy makers should consider the clinical and economic impact of this proposal.

Beyond PSA: The Role of Prostate Health Index (phi)

“…The second relevant limitation is the cost. Several studies simulated the impact of phi use on the total cost of diagnostic and therapeutic procedures for PCa patients [63][64][65][66][67].…”

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

“…The studies were based in the US (n = 5), UK (n = 4), Netherlands (n = 4), Hong Kong (n = 1), Germany (n = 1) and Canada (n = 1). All but two studies (18,19) carried out a cost-utility analysis where outcomes were measured in QALYs. The other two were cost-consequence analyses reporting the number of PSA tests and biopsies carried out and expected overall diagnostic costs (19) (18).…”

“…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.…”

“…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).…”

“…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). (20,26,42).…”