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Title: Incorporating biomarkers into the primary prostate biopsy setting: a cost-effectiveness analysis.
Austin Authors: Sathianathen, Niranjan J;Kuntz, Karen M;Alarid-Escudero, Fernando;Lawrentschuk, Nathan;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
Date: 2018-06-12
Publication information: The Journal of Urology 2018; 200(6): 1215-1220
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
Journal: The Journal of urology
PubMed URL: 29906434
Type: Journal Article
Subjects: biomarkers
cost analysis
cost savings
decision making
Prostate cancer
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