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

Christine L Barnett1,2, Matthew S Davenport3,4, Jeffrey S Montgomery4

  • 1RTI Health Solutions, Research Triangle Park, North Carolina.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|July 28, 2019
PubMed

Insights

Combining 18F-choline PET/multiparametric MRI (mpMRI) with targeted biopsy strategies significantly improves cost-effectiveness for detecting prostate cancer in men with elevated PSA. This approach reduces unnecessary biopsies by 35% compared to mpMRI alone.

Area of Science:

  • Urology
  • Radiology
  • Health Economics

Background:

  • Elevated prostate-specific antigen (PSA) levels in men necessitate accurate detection of primary prostate cancer (Gleason score ≥ 3 + 4).
  • Multiparametric MRI (mpMRI) is a key imaging modality, but its standalone effectiveness and cost-effectiveness in conjunction with novel PET tracers require evaluation.
  • Optimizing diagnostic pathways is crucial to balance detection rates, patient outcomes, and healthcare resource utilization.

Purpose of the Study:

  • To evaluate the cost-effectiveness of 18F-choline PET/mpMRI compared to mpMRI alone for detecting primary prostate cancer (Gleason score ≥ 3 + 4) in men with elevated PSA.
  • To assess different hybrid imaging and biopsy strategies to identify the most efficient diagnostic pathway.
  • To quantify the impact on health outcomes (quality-adjusted life years - QALYs) and economic consequences.

Main Methods:

  • A Markov model simulated prostate cancer onset and progression to estimate health and economic outcomes.
  • Evaluated hybrid 18F-choline PET/mpMRI strategies using Likert or PI-RADSv2 scoring, incorporating targeted biopsy protocols.
  • Compared these strategies against mpMRI alone with varying biopsy thresholds and universal standard biopsy protocols.

Main Results:

  • Hybrid 18F-choline PET/mpMRI with Likert scoring, combined biopsy for positive imaging, and no biopsy for negative imaging, yielded a cost-effectiveness of $22,706/QALY gained relative to mpMRI alone.
  • This optimal strategy reduced the number of biopsies by 35% compared to mpMRI alone.
  • Using PI-RADSv2 scoring resulted in a higher cost-effectiveness ratio ($46,867/QALY gained), and threshold analysis confirmed robustness even with reduced sensitivity/specificity.

Conclusions:

  • 18F-choline PET/mpMRI is a cost-effective strategy for detecting primary prostate cancer (Gleason score ≥ 3 + 4) in men with elevated PSA.
  • This integrated approach significantly reduces the rate of unnecessary biopsies compared to mpMRI alone.
  • The findings support the clinical utility of hybrid PET/mpMRI in optimizing prostate cancer diagnosis and resource allocation.
Keywords:
Markov modelPET/MRIcost-effectiveness analysisprostate biopsyprostate cancer

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