Agency for Care Effectiveness, Ministry of Health, Singapore, 16 College Road, Singapore, 169854, Singapore.
Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.
BMC Health Serv Res. 2021 Sep 3;21(1):909. doi: 10.1186/s12913-021-06916-0.
To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective.
A combined decision tree and Markov model was developed. The starting model population was men with mean age of 65 years referred for a first prostate biopsy due to clinical suspicion of prostate cancer. The six diagnostic strategies were selected for their relevance to local clinical practice. They comprised MRI targeted biopsy following a positive pre-biopsy multiparametric MRI (mpMRI) [Prostate Imaging - Reporting and Data System (PI-RADS) score ≥ 3], systematic biopsy, or saturation biopsy employed in different testing combinations and sequences. Deterministic base case analyses with sensitivity analyses were performed using costs from the healthcare system perspective and quality-adjusted life years (QALY) gained as the outcome measure to yield incremental cost-effectiveness ratios (ICERs).
Deterministic base case analyses showed that Strategy 1 (MRI targeted biopsy alone), Strategy 2 (MRI targeted biopsy ➔ systematic biopsy), and Strategy 4 (MRI targeted biopsy ➔ systematic biopsy ➔ saturation biopsy) were cost-effective options at a willingness-to-pay (WTP) threshold of US$20,000, with ICERs ranging from US$18,975 to US$19,458. Strategies involving MRI targeted biopsy in the repeat biopsy setting were dominated. Sensitivity analyses found the ICERs were affected mostly by changes to the annual discounting rate and prevalence of prostate cancer in men referred for first biopsy, ranging between US$15,755 to US$23,022. Probabilistic sensitivity analyses confirmed Strategy 1 to be the least costly, and Strategies 2 and 4 being the preferred strategies when WTP thresholds were US$20,000 and US$30,000, respectively.
This study found MRI targeted biopsy to be cost-effective in diagnosing prostate cancer in the biopsy-naïve setting in Singapore.
从新加坡医疗保健系统的角度出发，评估了 6 种涉及磁共振成像（MRI）靶向活检的诊断策略在初次和重复活检环境下诊断前列腺癌的成本效益。
建立了一个联合决策树和马尔可夫模型。起始模型人群为年龄均为 65 岁的男性，因临床怀疑前列腺癌而接受首次前列腺活检。选择这 6 种诊断策略是因为它们与当地临床实践相关。它们包括在阳性前列腺多参数 MRI（PI-RADS 评分≥3）前活检后进行 MRI 靶向活检、系统活检或饱和活检，以不同的测试组合和顺序进行。使用医疗保健系统视角下的成本和获得的质量调整生命年（QALY）作为结果衡量标准，进行确定性基本案例分析和敏感性分析，以产生增量成本效益比（ICER）。
确定性基本案例分析表明，在支付意愿（WTP）阈值为 20000 美元的情况下，策略 1（仅 MRI 靶向活检）、策略 2（MRI 靶向活检→系统活检）和策略 4（MRI 靶向活检→系统活检→饱和活检）是具有成本效益的选择，ICER 范围为 18975 美元至 19458 美元。涉及 MRI 靶向活检在重复活检环境中的策略处于主导地位。敏感性分析发现，ICER 主要受首次活检时男性前列腺癌的年度贴现率和患病率变化的影响，范围在 15755 美元至 23022 美元之间。概率敏感性分析证实，当 WTP 阈值分别为 20000 美元和 30000 美元时，策略 1 的成本最低，策略 2 和策略 4 是首选策略。
本研究发现，在新加坡，MRI 靶向活检在诊断活检初治患者的前列腺癌方面具有成本效益。
