Cost-Effectiveness of Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study

• Published in: Value in health Vol. 24; no. 12; pp. 1763 - 1772
• Main Authors: Hao, Shuang, Karlsson, Andreas, Heintz, Emelie, Elfström, K. Miriam, Nordström, Tobias, Clements, Mark
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021; Elsevier Science Ltd
• Subjects: Aged; Biopsy; Cancer screening; Cost analysis; Cost-Benefit Analysis; cost-effectiveness; Dominance; Generalizability; Heterogeneity; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - economics; Male; Mass Screening - economics; Medical screening; Medicin och hälsovetenskap; microsimulation; Middle Aged; Prostate; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms - diagnosis; Quality adjusted life years; screening; Sensitivity analysis; Sweden; Uncertainty; Utility functions; Sweden; cost-effectiveness; magnetic resonance imaging; prostate cancer; screening; Sweden; biopsy; microsimulation
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2021.06.001

This study aimed to assess the cost-effectiveness of magnetic resonance imaging (MRI) with combinations of targeted biopsy (TBx) and systematic biopsy (SBx) for early prostate cancer detection in Sweden. A cost-utility analysis was conducted from a lifetime societal perspective using a microsimulation model. Five strategies included no screening and quadrennial screening for men aged 55 to 69 years using SBx alone, TBx on positive MRI (MRI + TBx), combined TBx/SBx on positive MRI (MRI + TBx/SBx), and SBx on negative MRI with TBx/SBx on positive MRI (MRI − SBx, MRI + TBx/SBx). Test characteristics were based on a recent Cochrane review. We predicted the number of biopsies, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. The screening strategies were classified in Sweden as high costs per QALY gained compared with no screening. Using MRI + TBx and MRI + TBx/SBx reduced the number of biopsy episodes across a lifetime by approximately 40% compared with SBx alone. Both strategies showed strong dominance over SBx alone and MRI − SBx, MRI + TBx. Compared with MRI + TBx, the MRI + TBx/SBx strategy had an incremental cost-effectiveness ratio of more than €200 000 per QALY gained, which was classified in Sweden as a very high cost. These predictions were robust in the probabilistic sensitivity analysis. Limitations included generalizability of the model assumptions and uncertainty regarding the health-state values and study heterogeneity from the Cochrane review. MRI + TBx and MRI + TBx/SBx showed strong dominance over alternative screening strategies. MRI + TBx resulted in similar or marginally lower gains in QALYs and lower costs than MRI + TBx/SBx. MRI + TBx was considered the optimal choice among the screening strategies. •A recent Cochrane review found improved sensitivity and specificity of using magnetic resonance imaging (MRI) in detecting prostate cancer (PCa). The cost-effectiveness of MRI and targeted biopsy (TBx) with or without systematic biopsy (SBx) in PCa screening has only been assessed in the US setting with test characteristics taken from small studies. Previous economic evaluations mainly relied on the health-state values of patients with PCa that were consolidated from old studies and measured by different types of instruments.•This study evaluated the cost-effectiveness of PCa screening using MRI and TBx, with or without SBx, in Sweden. Meta-analyses were conducted to obtain the test characteristics using raw data from the studies included in the Cochrane review. An extended review was also performed to obtain the health-state values using more unified measures based on a recent review by Magnus et al.•Compared with screening with SBx alone, using MRI + TBx and MRI + TBx/SBx for PCa screening was associated with substantial reductions in the number of biopsy episodes across a lifetime. MRI + TBx and MRI + TBx/SBx showed strong dominance over other screening strategies and were classified in Sweden as high costs per quality-adjusted life-year compared with no screening. Among the screening strategies, MRI + TBx was the optimal choice in Sweden.