18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 2. Cost-Effectiveness Analysis

被引:10
作者
Barnett, Christine L. [1 ,2 ]
Davenport, Matthew S. [3 ,4 ]
Montgomery, Jeffrey S. [4 ]
Kunju, Lakshmi Priya [5 ]
Denton, Brian T. [2 ,4 ]
Piert, Morand [3 ]
机构
[1] RTI Hlth Solut, Res Triangle Pk, NC USA
[2] Univ Michigan, Dept Ind & Operat Engn, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Dept Radiol, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Dept Urol, Ann Arbor, MI 48109 USA
[5] Univ Michigan, Dept Pathol, Ann Arbor, MI 48109 USA
基金
美国国家科学基金会;
关键词
PET/MRI; prostate cancer; cost-effectiveness analysis; prostate biopsy; Markov model; BIOPSY; MEN; MRI; COMPLICATIONS; PROGRESSION; ULTRASOUND; PREVENTION; STRATEGIES; DIAGNOSIS; PET;
D O I
10.2967/jnumed.119.225771
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
The objective of this study was to evaluate the cost-effectiveness of F-18-choline PET/multiparametric MRI (mpMRI) versus mpMRI alone for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 in men with elevated prostate-specific antigen levels. Methods: A Markov model of prostate cancer onset and progression was used to estimate the health and economic consequences of F-18-choline PET/mpMRI for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 in men with elevated prostate-specific antigen levels. Multiple simultaneous hybrid F-18-choline PET/mpMRI strategies were evaluated using Likert or Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scoring; the first was biopsy for Likert 5 mpMRI lesions or Likert 3-4 lesionswith F-18-choline target-to-background ratios of greater than or equal to 1.58, and the second was biopsy for PI-RADSv2 5 mpMRI lesions or PI-RADSv2 3-4 mpMRI lesions with F-18-choline target-to-background ratios of greater than or equal to 1.58. These strategies were compared with universal standard biopsy, mpMRI alone with biopsy only for PI-RADSv2 3-5 lesions, and mpMRI alone with biopsy only for Likert 4-5 lesions. For each mpMRI strategy, either no biopsy or standard biopsy could be performed after negative mpMRI results were obtained. Deaths averted, quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios were estimated for each strategy. Results: When the results of F-18-choline PET/mpMRI were negative, performing a standard biopsy was more expensive and had lower QALYs than performing no biopsy. The best screening strategy among those considered in this study performed hybrid F-18-choline PET/mpMRI with Likert scoring on men with elevated PSA, performed combined biopsy (targeted biopsy and standard 12-core biopsy) for men with positive imaging results, and no biopsy for men with negative imaging results ($22,706/QALY gained relative to mpMRI alone); this strategy reduced the number of biopsies by 35% in comparison to mpMRI alone. When the same policies were compared using PI-RADSv2 instead of Likert scoring, hybrid F-18-choline PET/mpMRI cost $46,867/QALY gained relative to mpMRI alone. In a threshold analysis, the best strategy among those considered remained cost-effective when the sensitivity and specificity of PET/mpMRI and combined biopsy (targeted biopsy and standard 12-core biopsy) were simultaneously reduced by 20 percentage points. Conclusion: F-18-choline PET/mpMRI for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 is cost-effective and can reduce the number of unneeded biopsies in comparison to mpMRI alone.
引用
收藏
页码:1705 / 1712
页数:8
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