Department of Operating Rooms, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Department of Operating Rooms, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Eur Urol Oncol. 2018 Dec;1(6):476-483. doi: 10.1016/j.euo.2018.05.007. Epub 2018 Jun 5.
Active surveillance (AS) has limitations that include missing high-risk tumors and performing unnecessary biopsies. The use of multiparametric magnetic resonance imaging (mpMRI) in AS may overcome these limitations, but its cost-effectiveness remains uncertain.
To determine the cost-effectiveness of three AS strategies: AS with transrectal ultrasound-guided biopsy (TRUSGB), AS with mpMRI and MRI ultrasound-guided biopsy (MR-TRUSGB), and AS with mpMRI without biopsies.
DESIGN, SETTING, AND PARTICIPANTS: A Markov cohort model for men with low-risk prostate cancer was developed to assess the three strategies. Input data were derived from meta-analysis, other published literature, and national cost reports. A health care perspective was used for a European setting.
Health care costs and quality-adjusted life years (QALYs) were modeled over a lifetime horizon. Deterministic and probabilistic sensitivity analyses were performed to address uncertainty in model parameters.
In the base case analysis, expected mean costs per man screened were €5150 for TRUSGB, €5994 for mpMRI without biopsy, and €4848 for mpMRI with biopsy. Corresponding QALYs were higher for mpMRI with biopsy compared to TRUSGB (18.67 vs 18.66) and lower for mpMRI without biopsy compared to TRUSGB (18.27 vs 18.66). Owing to lower costs and higher effects, the mpMRI with biopsy strategy was cost-effective compared to the TRUSGB strategy.
mpMRI with MR-TRUSGB appears to be the most cost-effective AS strategy for men with low-risk prostate cancer.
We compared costs and quality of life for the standard active surveillance (AS) program for men diagnosed with low-risk prostate cancer to a monitoring program comprising multiparametric magnetic resonance imaging (mpMRI) with and without biopsies. Our results suggest that an AS strategy using mpMRI with biopsy improves quality of life and costs decrease. An AS strategy using mpMRI without biopsy was not beneficial compared to the standard program.
主动监测（AS）存在一些局限性，包括漏诊高危肿瘤和进行不必要的活检。在 AS 中使用多参数磁共振成像（mpMRI）可能会克服这些局限性，但它的成本效益仍不确定。
确定三种 AS 策略的成本效益：经直肠超声引导活检（TRUSGB）的 AS、mpMRI 和 MRI 超声引导活检（MR-TRUSGB）的 AS 以及无活检的 mpMRI 的 AS。
设计、设置和参与者：为评估这三种策略，为患有低危前列腺癌的男性开发了一个马尔可夫队列模型。输入数据来自荟萃分析、其他已发表的文献和国家成本报告。使用欧洲医疗保健视角。
在基本案例分析中，每位接受筛查的男性的预期平均医疗费用分别为 TRUSGB 为 5150 欧元，无活检的 mpMRI 为 5994 欧元，有活检的 mpMRI 为 4848 欧元。mpMRI 联合活检的预期平均质量调整生命年（QALY）高于 TRUSGB（18.67 比 18.66），而无活检的 mpMRI 低于 TRUSGB（18.27 比 18.66）。由于成本较低且效果较高，mpMRI 联合活检策略比 TRUSGB 策略更具成本效益。
对于患有低危前列腺癌的男性，mpMRI 联合 MR-TRUSGB 似乎是最具成本效益的 AS 策略。
我们将男性低危前列腺癌标准主动监测（AS）方案的成本和生活质量与包括有和无活检的多参数磁共振成像（mpMRI）监测方案进行了比较。我们的结果表明，使用 mpMRI 联合活检的 AS 策略可以提高生活质量，降低成本。与标准方案相比，使用无活检的 mpMRI 的 AS 策略没有益处。
