Publication

Cost-effectiveness of SelectMDx in prostate cancer risk assessment

Govers T, et al. J Urol 2018; doi: 10.1016/j.juro.2018.07.034

 

What was studied?

This study evaluated the health benefit and cost-effectiveness of SelectMDx in the USA. Current standard of care, in which men with an elevated PSA or abnormal DRE would undergo a TRUS-guided biopsy, was compared to a strategy in which SelectMDx was used to select men for biopsy.  

 

What were the main outcomes?

The use of SelectMDx resulted in a gain in quality adjusted life years (QALYs) and cost savings compared with standard of care. The potential cost saving was over $ 500 million for each year when using SelectMDx (Table 1).

The use of SelectMDx reduced the number of unnecessary biopsies and reduced overdiagnosis, i.e. the detection of clinically insignificant PCa (Table 2).  

 

Table 1. Gain in QALYs and cost savings when SelectMDx would be used to select men for biopsy compared to current standard of care

 

Per patient over 18 years

For cohort of men undergoing biopsy per year (N=311,879)

Gain in QALY

0.045

14,035

Cost savings ($)

1,694

528,323,026

 

Table 2. Clinical consequences when SelectMDx would be used to select men for biopsy

 

Biopsies while no (CS) PCa

(unnecessary biopsy)

Detected CI PCa

Missed CS PCa

Standard of care

77%

24%

0%

SelectMDx

37%

16%

1%

Difference

-41%

-8%

1%

Difference for cohort of men undergoing biopsy per year (N=311,878)

-126,387

-24,749

3,055

CI: clinically insignificant; CS: clinically significant; PCa: prostate cancer

     

What was concluded?

Routine use of SelectMDx to guide biopsy-decision making improves health outcomes and lowers costs in US men at risk for prostate cancer. The use of SelectMDx may optimise the value of prostate cancer risk assessment, which will become increasingly important in an era of financial accountability.

 

How was the study performed?

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

 

Decision tree

decision tree

CI: clinically insignificant; CS: clinically significant; PCa: prostate cancer; RP: radical prostatectomy; RT: radiation therapy; WW: watchful waiting

 

A Markov decision-analytic model was developed to calculate long-term QALYs and healthcare costs from the Medicare payer perspective for each strategy. Model parameters and input were derived from literature. 

Editor comment

Govers and colleagues demonstrated that the implementation of a diagnostic strategy based on the use of novel biomarkers such as the SelectMDx before prostate biopsy would lead to a significant reduction in the number of unnecessary biopsies performed without missing clinically significant disease. This, in turn, would result into substantial savings for patients and for the entire healthcare system. Although these findings are based on decision-analytic models and “real-life” studies are needed to confirm these simulations, the current study supports the notion that an upfront biopsy in men with elevated PSA levels should be avoided to reduce the morbidity of this procedure and the risks of overdiagnosis and overtreatment. Conversely, novel biomarkers and imaging modalities such as mpMRI should assist physicians in the identification of men more likely to harbour clinically significant disease who should, therefore, be considered for prostate biopsy. Further studies comparing biomarkers and imaging as triage tests for the selection of prostate biopsy candidates are needed to improve the diagnostic pathway of prostate cancer.

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

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