PD12-02 UTILIZATION AND OUTCOMES OF REPEAT PROSTATE BIOPSY IN A STATEWIDE QUALITY IMPROVEMENT COLLABORATIVE

Abstract

INTRODUCTION AND OBJECTIVES: Systematic 12-core transrectal ultrasound-guided biopsy (TRUSGB) is the recommended approach to diagnose prostate cancer (PCa). Overdiagnosis and sampling errors leading to incorrect risk stratification and treatment allocation represent major limitations. Multiparametric MRI is able to accurately identify PCa lesions within the prostate. Compared to random TRUSGB, MRI-guided targeted biopsy (MRGTB) has been shown to detect significant PCa in a higher proportion of men, using 1e4 cores instead of 12, and to reduce the diagnosis of insignificant PCa and thus overtreatment. Costs and technical limitations still prevent this promising approach from becoming the new standard in PCa diagnosis. The goal of the present study was to assess whether the added initial costs related to MRI are balanced with the benefits of MRGTB in a cost-effectiveness model. METHODS: A Markov model was developed to estimate the incremental cost-effectiveness ratio (ICER) over 10-, 15and 20 yr period. Study population consisted of men >50yr with a life expectancy >15yr and clinical suspicion of PCa. Based on previously published data, a simulation model taking into account the probability of men harboring PCa, the diagnostic accuracy of both procedures and the probability of being assigned to the various treatment options was developed. Medical (physician fees) and hospital costs (procedure fee, admission fee, tests andprocedures) basedonCanadiandatawere included. In order to avoid bias favoring MRGTB intervention, possible advantages of this intervention, such as decreased number of biopsy and change of PCa management, were not considered as base case but were tested in sensitivity analysis. ICER <50,000 CAD/QALY was considered as cost-effective. RESULTS: Following the standard systematic 12-core TRUSGB pathway, the calculated cumulative effects at 10-, 15and 20-year were 9.55, 13.56 and 16.66 years, respectively. When the MRGTB pathway was considered, cumulative effects were 9.65, 13.80 and 17.65 years, respectively. Costs related to the TRUSGB strategy were 9,762, 18,903 and 24,757 CAD at 10, 15 and 20 years, respectively, as compared to 15,112, 21,890 and 28,720 CAD for the MRGTB strategy. The corresponding 10-, 15and 20-year ICERs values when quality of life was taken into consideration were 22,043, 5,832 and 2,444 CAD/QALY, respectively. CONCLUSIONS: The incorporation of MRI and MRGTB in PCa diagnosis and management represents a cost-effective measure at 10, 15 and 20 years after initial diagnosis.