Publication

Cost-effectiveness of SelectMDx for prostate cancer in four European countries: a comparative modelling study

Govers T, Hessels D, Vlaeminck-Guillem V, et al. Prostate Cancer Prostatic Dis 2018: doi: 10.1038/s41391-018-0076-3.

 

What was studied?

This study assessed the health benefit and cost-effectiveness of SelectMDx in France, Germany, Italy and Spain. Current standard of care, in which men undergo a first biopsy in case of an elevated PSA, was compared to a strategy in which SelectMDx was used to select men for biopsy.

 

What were the main outcomes?

In all 4 countries, the use of SelectMDx resulted in a gain in quality adjusted life years (QALYs) and cost savings compared with standard of care. The potential total cost savings in the 4 countries was over €300 million for each year when using SelectMDx (Table).

The use of SelectMDx reduced the number of unnecessary biopsies and prevented the detection and overtreatment of clinically insignificant cancer. In all 4 countries, this outweighed the negative consequences associated with missing a small percentage of significant disease. 

 

Table. Gain in QALYs and cost savings per patient and for the total population when SelectMDx would be used to select men for biopsy compared to current standard of care

   

 

France

Germany

Italy

Spain

Per patient

 

 

 

 

Gain in QALY

0.022

0.016

0.031

0.020

Cost saving (€)

1,217

442

762

250

For the total population         

Gain in QALY

2886

2160

4255

1625

Cost saving (€)

159,659,447

59,661,160

104,579,166

20,310,500

 

The detection and treatment of insignificant prostate cancer had a large impact on costs and QALYs. According to the authors this is mostly due to a loss of quality of life owing to side-effects of radical treatment. In addition, men may experience loss of quality of life when they are on active surveillance and this negative effect seems not outweighed by the potential survival gain.

This study shows that health could be gained by preventing the detection of insignificant cancer. The SelectMDx test can prevent the detection of insignificant cancer and thereby prevent (over)diagnosis and overtreatment of insignificant cancers as currently observed in daily practice.         

 

What was concluded?

SelectMDx has the potential to improve health outcomes while saving costs in the initial diagnosis of prostate cancer. Together with prior studies performed in the US and the Netherlands, this study shows that the SelectMDx test is valuable in the context of different countries.

 

How was the study performed?

A decision model compared the current standard of care, in which men undergo a first biopsy in case of an elevated PSA, to a strategy in which SelectMDx was used to select men for biopsy.

Decision tree

decision tree
ADT: androgen deprivation therapy; AS: active surveillance; CI: clinically insignificant; CS: clinically significant; PCa: prostate cancer; RP: radical prostatectomy; RT: radiation therapy; WW: watchful waiting

 

A Markov model was developed to calculate long-term QALYs and healthcare costs for each strategy for France, Germany, Italy and Spain. Model parameters and input were derived from literature for each country.

Editor comment

Govers and colleagues elegantly showed that the integration of novel risk stratification tools such as the SelectMDx test in the diagnostic pathway of men with elevated PSA levels and suspicious prostate cancer might result into substantial savings for the healthcare system in different European countries. Although these findings might appear counterintuitive given the initial costs of the SelectMDx test, the benefits associated with its use would eventually result into savings for the healthcare system at long-term follow-up for three main reasons.

First, the negative predictive value of approximately 98% of the SelectMDx test would allow for avoiding unnecessary prostate biopsies in a substantial proportion of patients. This, in turn, would reduce the number of men at risk of experiencing morbidity (and mortality) typically associated with this invasive diagnostic procedure. Second, the reduction of the detection rate of clinically insignificant disease (i.e., overdiagnosis) would ultimately reduce the risk of overtreatment in the setting of localised prostate cancer. This, in turn, would allow for minimizing the risk of short- and long-term side effects of unnecessary treatments in patients diagnosed with a disease with a very low potential of becoming metastatic (i.e., clinically insignificant prostate cancer). Moreover, this approach would avoid stress and anxiety in a considerable proportion of men diagnosed with insignificant disease managed with active surveillance. Finally, the improved accuracy in the identification of clinically significant prostate cancer associated with the adoption of the SelectMDx test would allow for a timely diagnosis and treatment of more aggressive diseases.

Although prospective studies are needed to better assess the cost effectiveness of the implementation of novel diagnostic tests for prostate cancer in the clinical scenario, the decision model designed by Govers et al. supports these observations and strongly suggests that the use of the SelectMDx test might ultimately improve quality of life of men with suspicious prostate cancer while saving healthcare costs.

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

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