Quantifying downstream impact of inappropriate staging imaging in a cohort of veterans with low- and intermediate-risk incident prostate cancer

Drangsholt, Siri; Walter, Dawn; Ciprut, Shannon; Lepor, Abbey; Sedlander, Erica; Curnyn, Caitlin; Loeb, Stacy; Malloy, Patrick C.; Winn, Aaron N.; Makarov, Danil V.

doi:10.1016/j.urolonc.2018.11.022

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…It is possible that imaging could be driven by patient demands in hopes to reduce anxiety; however, a recent qualitative study has found that the decision to pursue imaging is largely driven by physician decision-making. 25 Additionally, research has shown that many men with low-risk disease who receive inappropriate imaging also receive false-positive test results, 3 which has been shown to increase anxiety in other cancers. 26,27 This study demonstrates the potential for cost-savings through appropriate imaging ordering practices.…”

Section: Discussionmentioning

confidence: 99%

“…Among these men, 43% received subsequent inappropriate imaging; we incorporated this into the model. 3 …”

Section: Methodsmentioning

confidence: 99%

“… 2 While imaging may yield useful additional information for some patients, for many imaging has a low probability of influencing treatment choices, and therefore, its harms outweigh its benefits. 3 , 4 Harms include emotional distress, wasteful spending, and increased cancer risk secondary to radiation exposure. On the other hand, underuse, or failure to provide appropriate imaging, can lead to delays in diagnosis, inadequate disease staging, and inappropriate treatment among patients who truly require care.…”

Section: Introductionmentioning

confidence: 99%

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The cost, survival, and quality‐of‐life implications of guideline‐discordant imaging for prostate cancer

et al. 2021

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Background: National Comprehensive Cancer Network (NCCN) guidelines for incident prostate cancer staging imaging have been widely circulated and accepted as best practice since 1996. Despite these clear guidelines, wasteful and potentially harmful inappropriate imaging of men with prostate cancer remains prevalent.Aim: To understand changing population-level patterns of imaging among men with incident prostate cancer, we created a state-transition microsimulation model based on existing literature and incident prostate cancer cases.Methods: To create a cohort of patients, we identified incident prostate cancer cases from 2004 to 2009 that were diagnosed in men ages 65 and older from SEER. A microsimulation model allowed us to explore how this cohort's survival, quality of life, and Medicare costs would be impacted by making imaging consistent with guidelines.We conducted a probabilistic analysis as well as one-way sensitivity analysis.Results: When only imaging high-risk men compared to the status quo, we found that the population rate of imaging dropped from 53 to 38% and average per-person spending on imaging dropped from $236 to $157. The discounted and undiscounted incremental cost-effectiveness ratios indicated that ideal upfront imaging reduced costs and slightly improved health outcomes compared with current practice patterns, that is, guideline-concordant imaging was less costly and slightly more effective. Conclusion:This study demonstrates the potential reduction in cost through the correction of inappropriate imaging practices. These findings highlight an opportunity within the healthcare system to reduce unnecessary costs and overtreatment through guideline adherence.

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