Cost-effectiveness of a new urinary biomarker-based risk score compared to standard of care in prostate cancer diagnostics - a decision analytical model

Using SelectMDx to identify men for prostate biopsy may reduce healthcare costs and improve health-related quality of life


Dijkstra S et al. BJU Int 2017;120:659-65


What was studied?

This study assessed the cost-effectiveness of SelectMDx compared with the current standard of care (SOC) to identify men (PSA >3ng/mL) for prostate biopsy in the Netherlands.


What were the main outcomes?

By using SelectMDx, healthcare costs could be reduced by €128, and 0.025 quality-adjusted life years (QALY) could be gained per patient, compared to the current SOC (Table).

This was mainly due to a reduction in the number of men diagnosed with low-grade prostate cancer (and subsequent treatment or active surveillance), and to a lesser extent to a reduction in the number of prostate biopsies.


Table. Comparison of the cost-effectiveness of SelectMDx and current standard of care (SOC) in prostate cancer diagnosis


Unnecessary biopsies (%)

Low-grade PCa detected (%)

High-grade PCa missed (%)

Mean cost per patient ()

QALY per patient

Men with PSA >3 ng/mL



















Men with PSA 3-10 ng/mL



















PCa: prostate cancer; QALY: quality-adjusted life years


What was concluded?

By implementing SelectMDx in a population of men with a PSA >3 ng/mL, patients in need for a prostate biopsy could be identified. This could lead to a reduction in healthcare costs and an improvement in quality of life compared to the current standard of care. SelectMDx may reduce overdiagnosis and overtreatment with a minor risk of missing high-grade prostate cancer.


How was the study performed?

A decision tree and a Markov model were developed comparing 2 strategies over an 18-year time horizon:

  1. SOC: all men with a PSA >3 ng/mL undergo a biopsy, and will, depending on the outcome, be followed with PSA measurements (in case of negative biopsy), receive active surveillance, radical treatment or watchful waiting
  2. SelectMDx: men with a PSA >3 ng/mL will undergo a SelectMDx test and get a biopsy depending on the test result. Based on the outcome of the biopsy men will be followed with PSA measurements (in case of negative biopsy), receive active surveillance, radical treatment or watchful waiting

The SelectMDx cut-off was chosen to correspond with a sensitivity of 95.7% for high-grade PCa.

Transition probabilities, utilities, and costs were derived from literature and expert opinion. Costs were based on the healthcare system in the Netherlands.



Editor comment

The current study demonstrates that the implementation of novel biomarkers (i.e., SelectMDx) in  clinical practice might reduce the number of unnecessary prostate biopsies by more than 40% without affecting the probability of identifying patients with clinically significant prostate cancer at TRUS-guided biopsy. This was particularly true when considering patients with a baseline PSA between 3 and 10 ng/ml, where the proportion of biopsies avoided approached 50%. Of note, the authors were able to prove that the benefits associated with the implementation of SelectMDx might translate into substantial cost savings for the healthcare system in a European country. Moreover, the reduction in the number of patients with clinically insignificant prostate cancer detected at TRUS-guided biopsies would eventually reduce the use of unnecessary treatments in this setting and, consequently, their side effects. This, in turn, would translate into additional benefits in terms of improved quality of life and reduced healthcare expenditures without affecting the long-term oncologic outcomes. Although Dijkstra and colleagues apply a rigorous statistical methodology in their study, further prospective trials are needed to confirm the benefits of the use of biomarkers such as SelectMDx in the clinical scenario.

Photo Dr. Giorgio Gandaglia
Dr. Giorgio Gandaglia
Vita-Salute San Raffaele University, Milan, Italy

It is nice to see that the biomarker test reduced both overdiagnosis and unnecessary complications due to biopsy, in turn reducing overall costs for the healthcare system.

Photo Prof. Christian Stief
Prof. Christian Stief
Ludwig-Maximilians-University, Munich, Germany

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