Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
Department ofRadiology, University of Michigan, Ann Arbor, MI, USA.
BJU Int. 2018 Jul;122(1):50-58. doi: 10.1111/bju.14151. Epub 2018 Mar 8.
To determine how best to use magnetic resonance imaging (MRI) and targeted MRI/ultrasonography fusion biopsy for early detection of prostate cancer (PCa) in men with elevated prostate-specific antigen (PSA) concentrations and whether it can be cost-effective.
A Markov model of PCa onset and progression was developed to estimate the health and economic consequences of PCa screening with MRI. Patients underwent PSA screening from ages 55 to 69 years. Patients with elevated PSA concentrations (>4 ng/mL) underwent MRI, followed by targeted fusion or combined (standard + targeted fusion) biopsy on positive MRI, and standard or no biopsy on negative MRI. Prostate Imaging Reporting and Data System (PI-RADS) score on MRI was used to determine biopsy decisions. Deaths averted, quality-adjusted life-years (QALYs), cost and incremental cost-effectiveness ratio (ICER) were estimated for each strategy.
With a negative MRI, standard biopsy was more expensive and had lower QALYs than performing no biopsy. The optimum screening strategy (ICER $23 483/QALY) recommended combined biopsy for patients with PI-RADS score ≥3 and no biopsy for patients with PI-RADS score <3, and reduced the number of screening biopsies by 15%. Threshold analysis suggests MRI continues to be cost-effective when the sensitivity and specificity of MRI and combined biopsy are simultaneously reduced by 19 percentage points.
Our analysis suggests MRI followed by targeted MRI/ultrasonography fusion biopsy can be a cost-effective approach to the early detection of PCa.
确定如何最好地利用磁共振成像（MRI）和靶向 MRI/超声融合活检来早期发现前列腺特异性抗原（PSA）浓度升高的男性中的前列腺癌（PCa），以及这种方法是否具有成本效益。
建立了一个 PCa 发病和进展的 Markov 模型，以估计 MRI 筛查 PCa 的健康和经济后果。患者在 55 岁至 69 岁之间接受 PSA 筛查。PSA 浓度升高（>4ng/mL）的患者接受 MRI，然后在 MRI 阳性时进行靶向融合或联合（标准+靶向融合）活检，如果 MRI 阴性则进行标准或无活检。MRI 上的前列腺成像报告和数据系统（PI-RADS）评分用于确定活检决策。为每种策略估计了避免的死亡人数、质量调整生命年（QALYs）、成本和增量成本效益比（ICER）。
如果 MRI 结果为阴性，标准活检比不活检更昂贵，且 QALYs 更低。最佳筛查策略（ICER 为 23483 美元/QALY）推荐对 PI-RADS 评分≥3 的患者进行联合活检，对 PI-RADS 评分<3 的患者进行无活检，同时减少 15%的筛查活检数量。阈值分析表明，当 MRI 的灵敏度和特异性同时降低 19 个百分点时，MRI 仍然具有成本效益。
我们的分析表明，MRI 后进行靶向 MRI/超声融合活检可以成为早期发现 PCa 的一种具有成本效益的方法。
