Venderink Wulphert, Govers Tim M, de Rooij Maarten, Fütterer Jurgen J, Sedelaar J P Michiel
1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
2 Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.
AJR Am J Roentgenol. 2017 May;208(5):1058-1063. doi: 10.2214/AJR.16.17322. Epub 2017 Feb 22.
Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective.
A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed.
The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective.
Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.
三种常用的前列腺活检方法分别是经直肠超声引导下的系统活检、直接孔内磁共振成像（MRI）引导活检和图像融合引导活检。本研究的目的是计算哪种策略最具成本效益。
构建决策树和马尔可夫模型以比较成本效益。文献综述和专家意见用作输入。如果获得一个质量调整生命年的成本（增量成本效益比）不超过80,000欧元（2017年1月约合85,000美元）的支付意愿阈值，则该策略被认为具有成本效益。进行了一项基础病例分析，以比较经直肠超声引导下的系统活检和图像融合引导活检。由于缺乏关于直接孔内MRI引导活检准确性的适当文献，因此进行了阈值分析。
与经直肠超声引导下的系统活检相比，融合引导活检的增量成本效益比为每获得一个质量调整生命年1386欧元（1470美元），低于支付意愿阈值，因此被认为具有成本效益。如果临床意义重大的前列腺癌患者的MRI检查结果正常，则直接孔内MRI引导活检的敏感性必须至少为88.8%。如果是这种情况，每获得一个质量调整生命年的增量成本效益比为80,000欧元，因此具有成本效益。
与经直肠超声引导下的系统活检相比，融合引导活检似乎具有成本效益。需要进一步研究以确定直接孔内MRI引导活检是否是最佳途径；在本研究中计算出了其具有成本效益的阈值。
