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Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

IMPORTANCE: Magnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this ap...

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Autores principales: Yun, Hyunkyung, Kim, Jin, Gandhe, Aishwarya, Nelson, Brianna, Hu, Jim C., Gulani, Vikas, Margolis, Daniel, Schackman, Bruce R., Jalali, Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687655/
https://www.ncbi.nlm.nih.gov/pubmed/38019516
http://dx.doi.org/10.1001/jamanetworkopen.2023.44856
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author Yun, Hyunkyung
Kim, Jin
Gandhe, Aishwarya
Nelson, Brianna
Hu, Jim C.
Gulani, Vikas
Margolis, Daniel
Schackman, Bruce R.
Jalali, Ali
author_facet Yun, Hyunkyung
Kim, Jin
Gandhe, Aishwarya
Nelson, Brianna
Hu, Jim C.
Gulani, Vikas
Margolis, Daniel
Schackman, Bruce R.
Jalali, Ali
author_sort Yun, Hyunkyung
collection PubMed
description IMPORTANCE: Magnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this approach in general and for different prostate-specific antigen (PSA) strata. OBJECTIVE: To examine the cost-effectiveness of integrating annual MRI and potential MRI-guided biopsy as part of clinical decision-making for men after being screened for prostate cancer compared with standard biopsy. DESIGN, SETTING, AND PARTICIPANTS: Using a decision analytic Markov cohort model, an economic evaluation was conducted projecting outcomes over 10 years for a hypothetical cohort of 65-year-old men in the US with 4 different PSA strata (<2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, >10 ng/mL) identified by screening through Monte Carlo microsimulation with 10 000 trials. Model inputs for probabilities, costs in 2020 US dollars, and quality-adjusted life-years (QALYs) were from the literature and expert consultation. The model was specifically designed to reflect the US health care system, adopting a federal payer perspective (ie, Medicare). EXPOSURES: Magnetic resonance imaging with potential MRI-guided biopsy and standard biopsy. MAIN OUTCOMES AND MEASURES: Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100 000 per QALY was estimated. One-way and probabilistic sensitivity analyses were performed. RESULTS: For the 3 PSA strata of 2.5 ng/mL or greater, the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard biopsy (PSA 2.5-4.0 ng/mL: base-case ICER, $21 131/QALY; PSA 4.1-10.0 ng/mL: base-case ICER, $12 336/QALY; PSA >10.0 ng/mL: base-case ICER, $6000/QALY). Results varied depending on the diagnostic accuracy of MRI and potential MRI-guided biopsy. Results of probabilistic sensitivity analyses showed that the MRI and potential MRI-guided biopsy strategy was cost-effective at the willingness-to-pay threshold of $100 000 per QALY in a range between 76% and 81% of simulations for each of the 3 PSA strata of 2.5 ng/mL or more. CONCLUSIONS AND RELEVANCE: This economic evaluation of a hypothetical cohort suggests that an annual MRI and potential MRI-guided biopsy was a cost-effective option from a US federal payer perspective compared with standard biopsy for newly eligible male Medicare beneficiaries with a serum PSA level of 2.5 ng/mL or more.
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spelling pubmed-106876552023-12-01 Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results Yun, Hyunkyung Kim, Jin Gandhe, Aishwarya Nelson, Brianna Hu, Jim C. Gulani, Vikas Margolis, Daniel Schackman, Bruce R. Jalali, Ali JAMA Netw Open Original Investigation IMPORTANCE: Magnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this approach in general and for different prostate-specific antigen (PSA) strata. OBJECTIVE: To examine the cost-effectiveness of integrating annual MRI and potential MRI-guided biopsy as part of clinical decision-making for men after being screened for prostate cancer compared with standard biopsy. DESIGN, SETTING, AND PARTICIPANTS: Using a decision analytic Markov cohort model, an economic evaluation was conducted projecting outcomes over 10 years for a hypothetical cohort of 65-year-old men in the US with 4 different PSA strata (<2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, >10 ng/mL) identified by screening through Monte Carlo microsimulation with 10 000 trials. Model inputs for probabilities, costs in 2020 US dollars, and quality-adjusted life-years (QALYs) were from the literature and expert consultation. The model was specifically designed to reflect the US health care system, adopting a federal payer perspective (ie, Medicare). EXPOSURES: Magnetic resonance imaging with potential MRI-guided biopsy and standard biopsy. MAIN OUTCOMES AND MEASURES: Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100 000 per QALY was estimated. One-way and probabilistic sensitivity analyses were performed. RESULTS: For the 3 PSA strata of 2.5 ng/mL or greater, the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard biopsy (PSA 2.5-4.0 ng/mL: base-case ICER, $21 131/QALY; PSA 4.1-10.0 ng/mL: base-case ICER, $12 336/QALY; PSA >10.0 ng/mL: base-case ICER, $6000/QALY). Results varied depending on the diagnostic accuracy of MRI and potential MRI-guided biopsy. Results of probabilistic sensitivity analyses showed that the MRI and potential MRI-guided biopsy strategy was cost-effective at the willingness-to-pay threshold of $100 000 per QALY in a range between 76% and 81% of simulations for each of the 3 PSA strata of 2.5 ng/mL or more. CONCLUSIONS AND RELEVANCE: This economic evaluation of a hypothetical cohort suggests that an annual MRI and potential MRI-guided biopsy was a cost-effective option from a US federal payer perspective compared with standard biopsy for newly eligible male Medicare beneficiaries with a serum PSA level of 2.5 ng/mL or more. American Medical Association 2023-11-29 /pmc/articles/PMC10687655/ /pubmed/38019516 http://dx.doi.org/10.1001/jamanetworkopen.2023.44856 Text en Copyright 2023 Yun H et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Yun, Hyunkyung
Kim, Jin
Gandhe, Aishwarya
Nelson, Brianna
Hu, Jim C.
Gulani, Vikas
Margolis, Daniel
Schackman, Bruce R.
Jalali, Ali
Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results
title Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results
title_full Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results
title_fullStr Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results
title_full_unstemmed Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results
title_short Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results
title_sort cost-effectiveness of annual prostate mri and potential mri-guided biopsy after prostate-specific antigen test results
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687655/
https://www.ncbi.nlm.nih.gov/pubmed/38019516
http://dx.doi.org/10.1001/jamanetworkopen.2023.44856
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