Abstract
This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography (SWE) imaging in comparison to pre-biopsy multiparametric magnetic resonance imaging (mpMRI) in men with suspected prostate cancer. This research is motivated by the early evidence of the good performance of SWE in distinguishing cancerous from benign prostate tissues. We used a decision analysis model representing the care-pathways of men referred with a high prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) in a UK setting from the payer’s perspective with results reported in 2016 GBP. We then appraised the cost-effectiveness of a novel approach based on SWE compared to the more conventional and widely practiced mpMRI-based approaches using data reported in the literature. Deterministic and probabilistic sensitivity analyses were used to address uncertainty regarding the parameter values utilised. Our exploratory results implied that SWE approach yielded an additional quality-adjusted life year (QALY) at the cost of GBP 10,048 compared to the standard mpMRI-based approach in the UK. This is lower than the official willingness to pay threshold of GBP 20,000 (the UK healthcare system guidelines) and is therefore a suitable replacement for the current practice. Sensitivity analyses confirmed the robustness of our results.
Highlights
In many countries across the world, especially those with advanced healthcare systems, cost-effectiveness analyses form the backbone of decision making on the allocation of limited resources to maximise efficiency and health benefits
This paper considers the case of prostate cancer where multiparametric magnetic resonance imaging has an established detection record [2,3] and is recommended by the National Institute for Health and Care Excellence (NICE) as the first-line investigation for people with suspected clinically localised prostate cancer followed up by mpMRIguided transrectal ultrasound (MRI-TRUS) fusion biopsy when required [4]
We evaluated and compared the cost-effectiveness of the following diagnosis strategies: (i) using mpMRI examination followed by MRI-TRUS fusion biopsy only if the diagnostic MRI result is positive—otherwise no biopsy at all; (ii) using mpMRI examination followed by MRI-TRUS fusion biopsy if results are positive, standard biopsies (TRUS guided biopsy) otherwise; and (iii) using shear wave elastography (SWE) followed by TRUS guide biopsy in SWE-detected lesions
Summary
In many countries across the world, especially those with advanced healthcare systems, cost-effectiveness analyses form the backbone of decision making on the allocation of limited resources to maximise efficiency and health benefits These analyses are revised when a serious alternative method of diagnosis and/or treatment of a considerable disease is developed. In addition to standard functions, SWE utilises the quantification of stiffness based on colour-coded images on screen, along with conventional ultrasound with much higher resolution (frame rate of 20–40,000/s). This is a much-needed improvement to cover inter-observer variation between radiologists and protocol variations in centres using MRI-based approaches [8]
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