Biopsies that rely on MRI to detect prostate cancer are worth the cost, according to research published online November 29 in JAMA Network Open.
Investigators ran a simulation of a hypothetical group of 65-year-old men who were at risk for the cancer, as indicated by their prostate-specific antigen (PSA) levels.
The costs and benefits of periodic ultrasound biopsies were modeled in comparison with those of an annual MRI plus MRI-guided biopsies using epidemiologic and clinical data.
The investigators compared the cost-effectiveness of each biopsy approach over a decade, as measured by the cost of procedures divided by the projected gain in life-years.
Cost-effectiveness was defined as less than $100,000 for each life-year gain using an MRI in comparison with ultrasound.
They stratified the cost-effectiveness of the MRI approach by severity of PSA level: <2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, and >10.0 ng/mL.
For three of the four PSA levels ― 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, and >10.0 ng/mL ― the combination of MRI plus MRI-guided biopsy was cost-effective.
The MRI-based approach cost $6000 more than ultrasound for each life-year gained at the highest PSA level of >10.0 ng/mL, which was significantly below the $100,000 threshold.
At the lowest PSA level of <2.5 ng/mL, the difference between MRI and ultrasound was $187,000, which was above the threshold.
The researchers wrote that there is “a growing consensus that the use of MRI and potential MRI-guided biopsy is cost-effective.”
Ali Jalali, PhD, a health economist at Weill Cornell Medicine, Cornell University, is the senior author of the study. Simulation data come from the National Vital Statistics Report of the Centers for Disease Control and Prevention and the Medicare fee schedule.
The study is a hypothetical simulation of what could happen under different conditions, not an analysis of data developed over time in clinical practice. It also assumes that PSA levels remain constant over time.
One author receives grants from Siemens Healthineers for MRI technology development, and another author consults for Promaxo Inc, which develops MRI tools.
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