MP46-15 COST EFFECTIVENESS OF MRI BEFORE PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2016MP46-15 COST EFFECTIVENESS OF MRI BEFORE PROSTATE BIOPSY Shivani Pahwa, Nicholas Schiltz, Lee Ponsky, Ziang Lu, Sara Dastmalchian, Robert Abouassaly, Mark Griswold, and Vikas Gulani Shivani PahwaShivani Pahwa More articles by this author , Nicholas SchiltzNicholas Schiltz More articles by this author , Lee PonskyLee Ponsky More articles by this author , Ziang LuZiang Lu More articles by this author , Sara DastmalchianSara Dastmalchian More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Mark GriswoldMark Griswold More articles by this author , and Vikas GulaniVikas Gulani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.313AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite high sensitivity and specificity, there is a reluctance to incorporate MRI prior to biopsy into practice guidelines for prostate cancer due to concerns about cost. We examined the cost effectiveness of MRI in the management of prostate cancer, and discuss the implications of this analysis. METHODS An extensive model of treatment algorithms for prostate cancer was created using base cases of a biopsy-naive man in three age groups (41-50 years, 51-60 years, and 61-70 years). The following strategies were evaluated: 1) Detecting prostate cancer with transrectal ultrasound (TRUS) guided biopsy 2) Performing MRI before biopsy to guide targeted biopsy using one of three strategies: (a) Cognitive guidance (b) MRI-ultrasound fusion and (c) in-gantry MR biopsy. 3) Performing MRI before biopsy and doing standard TRUS biopsy even when MR does not depict suspicious lesions. The cost effectiveness of a contrast enhanced exam was examined by further simulating each strategy with and without Gadolinium contrast. Prevalence of prostate cancer, probability of detecting significant cancer on MRI and standard TRUS biopsy, sensitivity and specificity of each technique, the probability of a patient choosing a given treatment pathway, the cost of these pathways, complication rate, and Quality Adjusted Life Years (QALY) values for each strategy, procedure costs (MRI exam/TRUS biopsy/MRI-guided biopsy), pathology costs, cost of losing a day of work, and cost of complications were derived from the literature and the Bureau of Labor Statistics. A decision tree model was formed using TreeAge Pro Healthcare (Williamstown, MA) software. A willingness-to-pay (WTP) threshold of $50,000 per QALY was used. Incremental cost and incremental QALYs per strategy, and Incremental cost effectiveness ratio (ICER) per QALY gained were calculated using TRUS biopsy as the common comparator group. RESULTS Table 1 summarizes each MR strategy with associated incremental QALY and ICER- Higher QALY and minimized ICER are desirable. Cognitive biopsy and MR in gantry were most cost effective strategies - MR in-gantry biopsy yielded higher QALY. CONCLUSIONS Improvement in detection of prostate cancer using MRI appears to provide substantial benefit to the patient as measured by QALY and is likely to outweigh the marginal increase in costs. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e622-e623 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shivani Pahwa More articles by this author Nicholas Schiltz More articles by this author Lee Ponsky More articles by this author Ziang Lu More articles by this author Sara Dastmalchian More articles by this author Robert Abouassaly More articles by this author Mark Griswold More articles by this author Vikas Gulani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...