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Title: Incorporating biomarkers into the primary prostate biopsy setting: a cost-effectiveness analysis.
Authors: Sathianathen, Niranjan J;Kuntz, Karen M;Alarid-Escudero, Fernando;Lawrentschuk, Nathan L;Bolton, Damien M;Murphy, Declan G;Weight, Christopher J;Konety, Badrinath R
Affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
Department of Surgery, Urology Unit, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
Issue Date: 2018
EDate: 2018-06-12
Citation: The Journal of Urology 2018; online first: 12 June
Abstract: To perform a cost-effectiveness analysis of using Prostate Health Index (PHI), 4Kscore, SelectMDx and ExoDx Prostate IntelliScore (EPI) in men with an elevated PSA value to determine the need for biopsy. We developed a decision-analytic model for men with an elevated PSA values (≥ 3ng/mL) where one of the biomarker tests was to determine which hypothetical individuals required a biopsy. In the current standard of care strategy, all individuals underwent a biopsy. Model parameters were derived from a comprehensive review of the literature. Costs were calculated from a health sector perspective and converted into 2017 US dollars. The cost and QALYs of the current standard of care (transrectal ultrasound guided biopsy) was $3,863 and 18.085, respectively. The use of any of the three biomarkers improved quality-adjusted survival compared to the current standard of care. The cost of SelectMDx, PHI and EPI was lower than performing a prostate biopsy on all patients. However, PHI was more costly and less effective than the SelectMDx strategy. EPI provided the highest QALY with an incremental cost-effectiveness ratio of $58,404 per QALY. The use of biomarkers could reduce the number of unnecessary biopsies by 24-34% compared to the current standard of care. The use of biomarkers in men with an elevated PSA to determine the need for biopsy improves quality-adjusted survival by decreasing the number of biopsies performed and treatment of indolent disease. Obtaining a SelectMDx or EPI following an elevated PSA but before proceeding to a biopsy are cost-effective strategies in this setting.
DOI: 10.1016/j.juro.2018.06.016
ORCID: 0000-0001-8553-5618
PubMed URL: 29906434
Type: Journal Article
Subjects: biomarkers
cost analysis
cost savings
decision making
Prostate cancer
Appears in Collections:Journal articles

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