Economic evaluation of the introduction of the Prostate Health Index as a rule-out test to avoid unnecessary biopsies in men with prostate specific antigen levels of 4-10 in Hong Kong
Economic evaluation of the introduction of the Prostate Health Index as a rule-out test to avoid unnecessary biopsies in men with prostate specific antigen levels of 4-10 in Hong Kong
复制标题
DOI：
10.1371/journal.pone.0215279
复制
发表时间：
2019-04-16
期刊：
影响因子：
3.7
通讯作者：
Hawkins, Neil
中科院分区：
文献类型：
--
作者：
Bouttell, Janet;Teoh, Jeremy;Hawkins, Neil
最近的一项研究显示，在香港，前列腺健康指数可避免前列腺特异性抗原4- 10 ng/ml和直肠指检正常的男性在诊断前列腺癌时进行不必要的活检。本研究旨在对在香港公共卫生服务中采用这种市售检测方法的影响进行经济评估，以确定是否有必要进行进一步研究。进行了一项成本后果分析，比较了目前的诊断途径与使用前列腺健康指数的拟议诊断途径。该模型的数据来自一项前瞻性队列研究，该研究在单机构和微成本研究中招募。使用35分的临界PHI评分来避免活检将花费3，000港元，并节省每名患者7，988港元的活检费用，并减少活检相关不良事件511港元。根据基本情况假设，该变动的净成本影响估计为5，500港元。在所有级别癌症的基础病例敏感性和特异性（分别为61.3%和77.5%）中，4.22%的人群中所有级别癌症可能被遗漏，0.53%的人群中高级别癌症可能被遗漏。将前列腺健康指数引入香港前列腺癌的诊断途径，有可能减少活检、活检成本和活检相关不良事件。政策制定者应该考虑这一建议的临床和经济影响。
A recent study showed that the Prostate Health Index may avoid unnecessary biopsies in men with prostate specific antigen 4-10ng/ml and normal digital rectal examination in the diagnosis of prostate cancer in Hong Kong. This study aimed to conduct an economic evaluation of the impact of adopting this commercially-available test in the Hong Kong public health service to determine whether further research is justified. A cost-consequence analysis was undertaken comparing the current diagnostic pathway with a proposed diagnostic pathway using the Prostate Health Index. Data for the model was taken from a prospective cohort study recruited at a single-institution and micro-costing studies. Using a cut off PHI score of 35 to avoid biopsy would cost HK$3,000 and save HK$7,988 per patient in biopsy costs and HK$511 from a reduction in biopsy-related adverse events. The net cost impact of the change was estimated to be HK$5,500 under base case assumptions. At the base case sensitivity and specificity for all grades of cancer (61.3% and 77.5% respectively) all grade cancer could be missed in 4.22% of the population and high grade cancer in 0.53%. The introduction of the prostate health index into the diagnostic pathway for prostate cancer in Hong Kong has the potential to reduce biopsies, biopsy costs and biopsy-related adverse events. Policy makers should consider the clinical and economic impact of this proposal.