Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York.
Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island.
JAMA Netw Open. 2023 Nov 1;6(11):e2344856. doi: 10.1001/jamanetworkopen.2023.44856.
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.
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).
Magnetic resonance imaging with potential MRI-guided biopsy and standard biopsy.
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.
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.
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.
磁共振成像（MRI）和潜在的 MRI 引导活检能够增强对临床显著前列腺癌的识别。尽管已证明其具有疗效，但 MRI 和潜在的 MRI 引导活检仍然昂贵，而且关于这种方法在一般情况下以及在不同前列腺特异性抗原（PSA）分层中的成本效益的证据有限。
与标准活检相比，检查将年度 MRI 和潜在的 MRI 引导活检纳入前列腺癌筛查后男性临床决策中的成本效益，与标准活检相比。
设计、设置和参与者：使用决策分析马尔可夫队列模型，通过蒙特卡罗微模拟对美国 65 岁的假设队列进行了 10 年的预测，该模型基于不同 PSA 分层（<2.5 ng/mL、2.5-4.0 ng/mL、4.1-10.0 ng/mL、>10 ng/mL）进行筛查，每个 PSA 分层有 10000 次试验。概率、2020 年美元成本和质量调整生命年（QALY）的模型输入来自文献和专家咨询。该模型专门设计用于反映美国医疗保健系统，采用联邦支付者视角（即医疗保险）。
MRI 联合潜在的 MRI 引导活检和标准活检。
使用愿意支付每 QALY 100000 美元的意愿支付阈值，估计增量成本效益比（ICER）。进行了单因素和概率敏感性分析。
对于 PSA 为 2.5 ng/mL 或更高的 3 个 PSA 分层，MRI 和潜在的 MRI 引导活检策略与标准活检相比具有成本效益（PSA 2.5-4.0 ng/mL：基本情况 ICER，21131 美元/QALY；PSA 4.1-10.0 ng/mL：基本情况 ICER，12336 美元/QALY；PSA >10.0 ng/mL：基本情况 ICER，6000 美元/QALY）。结果取决于 MRI 和潜在的 MRI 引导活检的诊断准确性。概率敏感性分析的结果表明，对于每个 PSA 为 2.5 ng/mL 或更高的 3 个分层，MRI 和潜在的 MRI 引导活检策略在从联邦支付者的角度来看，在 76%至 81%的模拟中，MRI 和潜在的 MRI 引导活检策略在愿意支付每 QALY 100000 美元的阈值内具有成本效益。
这项对假设队列的经济评估表明，与标准活检相比，对于新符合条件的血清 PSA 水平为 2.5 ng/mL 或更高的 Medicare 男性受益人的联邦支付者而言，年度 MRI 和潜在的 MRI 引导活检是一种具有成本效益的选择。
