Cost-effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer
Cost-effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer
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DOI：
10.1111/bju.14151
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发表时间：
2018-07-01
影响因子：
4.5
通讯作者：
Denton, Brian T.
中科院分区：
文献类型：
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作者：
Barnett, Christine L.;Davenport, Matthew S.;Denton, Brian T.
目的探讨磁共振成像（MRI）和靶向MRI/超声融合活检在前列腺特异性抗原（PSA）浓度升高的男性前列腺癌（PCa）早期检测中的最佳方法及是否具有成本效益。方法建立前列腺癌发病和进展的马尔可夫模型，评估MRI筛查前列腺癌的健康和经济后果。患者在55岁至69岁之间接受PSA筛查。PSA浓度升高（bb0 4ng/mL）的患者行MRI检查，阳性MRI行靶向融合或联合（标准+靶向融合）活检，阴性MRI行标准活检或不活检。前列腺成像报告和数据系统（PI-RADS） MRI评分用于确定活检决定。对每种策略的避免死亡、质量调整生命年（QALYs）、成本和增量成本-效果比（ICER）进行了估计。结果MRI阴性时，标准活检比不活检更昂贵，QALYs更低。最佳筛选策略（ICER $ 23483 /QALY）推荐PI-RADS评分为3分的患者联合活检，PI-RADS评分为3分的患者不活检
ObjectiveTo determine how best to use magnetic resonance imaging (MRI) and targeted MRI/ultrasonography fusion biopsy for early detection of prostate cancer (PCa) in men with elevated prostate-specific antigen (PSA) concentrations and whether it can be cost-effective.MethodsA Markov model of PCa onset and progression was developed to estimate the health and economic consequences of PCa screening with MRI. Patients underwent PSA screening from ages 55 to 69years. Patients with elevated PSA concentrations (>4ng/mL) underwent MRI, followed by targeted fusion or combined (standard + targeted fusion) biopsy on positive MRI, and standard or no biopsy on negative MRI. Prostate Imaging Reporting and Data System (PI-RADS) score on MRI was used to determine biopsy decisions. Deaths averted, quality-adjusted life-years (QALYs), cost and incremental cost-effectiveness ratio (ICER) were estimated for each strategy.ResultsWith a negative MRI, standard biopsy was more expensive and had lower QALYs than performing no biopsy. The optimum screening strategy (ICER $23 483/QALY) recommended combined biopsy for patients with PI-RADS score 3 and no biopsy for patients with PI-RADS score