135 COST-ANALYSIS OF PCA3 VERSUS PSA IN THE DETECTION OF PROSTATE CANCER IN MEN WITH A PRIOR NEGATIVE BIOPSY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2012135 COST-ANALYSIS OF PCA3 VERSUS PSA IN THE DETECTION OF PROSTATE CANCER IN MEN WITH A PRIOR NEGATIVE BIOPSY Kenneth Nepple, Seth Strope, Adam Kibel, Gundarshan Sandhu, Lucas Wiegand, and Steven Kymes Kenneth NeppleKenneth Nepple St. Louis, MO More articles by this author , Seth StropeSeth Strope St. Louis, MO More articles by this author , Adam KibelAdam Kibel Boston, MA More articles by this author , Gundarshan SandhuGundarshan Sandhu St. Louis, MO More articles by this author , Lucas WiegandLucas Wiegand St. Louis, MO More articles by this author , and Steven KymesSteven Kymes St. Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The objective of this study was to perform a cost-analysis of PCA3 versus PSA in men with a prior negative prostate biopsy by assessing both the cost of testing and the costs of prostate biopsy and complications. METHODS A cost-analysis model was used to evaluate the cost in US dollars associated with testing and prostate biopsy. Base case was a male with a history of a negative prostate biopsy tested by PCA3 or PSA to evaluate for prostate cancer. Primary analysis was performed from the healthcare payer perspective. Model probabilities were derived from published data including ROC curves in the placebo arm of the REDUCE trial of men who had both PCA3 and PSA testing. PCA3 and PSA were compared at points on the ROC curves with equal sensitivity (cancer detection) but different specificity. Sensitivity analysis of the model was performed. RESULTS Outcomes (see Table 1) and costs (see Table 2) of the model are shown. On rollback analysis in the model, average total patient cost was $528 for PCA3 compared to $383 for PSA, an incremental cost of $145 for each patient with PCA3 testing. PCA3 testing avoided 12 unnecessary biopsies per 100 men. On univariate sensitivity analysis the model was sensitive to changes in PCA3 cost or prostate biopsy costs, but insensitive to improved test specificity. PCA3 testing was cost equivalent with PCA3 cost of <$136. On two-way sensitivity analysis (see Figure), some combinations of lower PCA3 costs or higher prostate biopsy costs created scenarios where overall cost savings in fewer false positives with PCA3 outweighed the increased initial cost of PCA3. Table 1. Model outcomes in hypothetical cohort of 100 men with history of elevated PSA and prior negative biopsy Outcomes in 100 men PCA3 PSA Cancer missed 9.1 9.1 Prostate biopsies 26.2 37.8 Cancer on biopsy 8.6 8.6 Unnecessary biopsy 17.6 29.3 Prostate biopsy complications No complication 25.4 36.7 Outpatient UTI 0.2 0.3 Hospital admission 0.5 0.7 Table 2. Model costs in hypothetical cohort of 100 men with history of elevated PSA and prior negative biopsy Costs in 100 men PCA3 PSA Diagnostic testing $28,100 $2,600 Prostate biopsies $21,964 $31,700 Outpatient UTI's $63 $91 Hospital admissions $2,709 $3,910 Total costs in 100 men $52,836 $38,301 CONCLUSIONS Men with a history of a negative biopsy are 2-3 times more likely to have an unnecessary biopsy than to have cancer detected. Using current cost estimates, the beneficial decrease in biopsy and complication cost does not overcome the initial test cost of PCA3. However at lower PCA3 costs or higher prostate biopsy costs, PCA3 testing leads to a net savings compared to PSA. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e55-e56 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth Nepple St. Louis, MO More articles by this author Seth Strope St. Louis, MO More articles by this author Adam Kibel Boston, MA More articles by this author Gundarshan Sandhu St. Louis, MO More articles by this author Lucas Wiegand St. Louis, MO More articles by this author Steven Kymes St. Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...