Cost-effectiveness of Prostate Cancer Screening Using Magnetic Resonance Imaging or Standard Biopsy Based on the...

Area of Science:

• Urology
• Oncology
• Health Economics

Background:

• Prostate-specific antigen (PSA) testing combined with magnetic resonance imaging (MRI) for prostate cancer detection is rarely evaluated in a screening context.
• The STHLM3-MRI study demonstrated benefits of MRI with targeted and standard biopsies versus standard biopsies alone.

Purpose of the Study:

• To investigate the cost-effectiveness of prostate cancer screening using MRI with combined targeted and standard biopsies versus standard biopsies alone in Swedish men aged 55-69.
• To compare these strategies based on evidence from the STHLM3-MRI study.

Main Methods:

• Economic evaluation using a lifetime healthcare perspective and a microsimulation model.
• Simulated scenarios included no screening, PSA screening with standard biopsies, and MRI-based screening with combined biopsies.
• Input parameters derived from the STHLM3-MRI study and recent reviews; sensitivity analyses performed.

Main Results:

• MRI-based screening reduced lifetime prostate cancer deaths by 6-9% compared to no screening.
• Screening with MRI and combined biopsies yielded an ICER of $53,736 per QALY gained (moderate cost-effectiveness).
• MRI-based screening reduced lifetime biopsies and overdiagnosis by approximately 50% compared to standard biopsies alone, with a high probability of cost-effectiveness.

Conclusions:

• PSA testing followed by MRI with combined targeted and standard biopsies shows a high probability of being more cost-effective than traditional PSA and standard biopsy screening.
• MRI-based screening may be a valuable option for early prostate cancer detection in Sweden.