Budget Impact Model for the Use of PCA3 Urine Testing in Prostate Cancer Screening

Abstract

IntroductionContinued prostate cancer screening with serum prostate specific antigen in patients with a history of a negative prostate biopsy can result in unnecessary repeat prostate biopsies with significant morbidity and cost. The PCA3 molecular urine test has been shown to be an independent predictor of the diagnosis of significant prostate cancer in men who are still at risk after a negative prostate biopsy. We used a budget impact model to study the potential reduction in unnecessary prostate biopsies and the cost benefits in this population. MethodsIn a theoretical population of 1 million people during a 1-year time frame, the number of prostate biopsies and the costs were compared between a traditional method of prostate cancer screening (eg prostate specific antigen screening) after an initial negative prostate biopsy and a new method incorporating the PCA3 urine test after an increased prostate specific antigen. Men with abnormal results would undergo repeat prostate biopsy. ResultsIn the traditional method 959 repeat prostate biopsies would be performed at a fully weighted cost of $1,866,214. When PCA3 was used in the new method, 400 prostate biopsies would be performed at a fully weighted cost of $931,000, resulting in a cost savings of $935,214. ConclusionsThe incorporation of the PCA3 urine test into our decision algorithm for men at risk for prostate cancer after an initial negative prostate biopsy will result in a significant reduction in unnecessary biopsies with significant cost savings.