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Cost-Effectiveness and Evidence Gaps Surrounding PSMA-PET for Recurrent Prostate Cancer Evaluation.

Natalia Kunst1,2,3, Jessica B Long2,3, Preston C Sprenkle4

  • 1Centre for Health Economics, University of York, York, United Kingdom.

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Prostate-specific membrane antigen positron emission tomography (PSMA-PET) improves prostate cancer detection but may increase costs, potentially offsetting benefits. Further research is needed to identify patient groups where PSMA-PET offers the greatest value.

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Area of Science:

  • Oncology
  • Molecular Imaging
  • Health Economics

Background:

  • Prostate-specific membrane antigen positron emission tomography (PSMA-PET) enhances detection of advanced prostate cancer.
  • The cost-effectiveness of implementing PSMA-PET in clinical practice remains poorly defined.
  • Biochemical recurrence (BCR) of prostate cancer necessitates accurate staging and cost-effective evaluation.

Purpose of the Study:

  • To estimate lifetime health and cost outcomes of using PSMA-PET in patients with BCR prostate cancer.
  • To evaluate the cost-effectiveness of PSMA-PET compared to standard imaging.
  • To assess uncertainty and identify needs for future data collection.

Main Methods:

  • A decision-analytic model, including a decision tree and Markov model, was developed.
  • The model was informed by published literature and a study of patients with BCR undergoing PSMA-PET.
  • Lifetime quality-adjusted life-years (QALYs) and costs were simulated, with incremental cost-effectiveness ratios (ICERs) calculated.

Main Results:

  • Up-front PSMA-PET yielded higher QALYs (7.12) but also higher costs ($451,000) compared to CTBS (6.55 QALYs, $351,000).
  • The ICER for PSMA-PET was $172,000 per QALY, exceeding the $150,000 willingness-to-pay threshold.
  • In patients with lower PSA levels (<2 ng/mL), PSMA-PET showed a potential ICER of $113,000/QALY, suggesting cost-effectiveness.

Conclusions:

  • PSMA-PET may improve disease detection but might not be cost-effective due to high costs outweighing moderate QALY gains.
  • Further research is crucial to pinpoint patient subsets and clinical scenarios where molecular imaging provides maximum value.
  • Addressing decisional uncertainty through additional data could significantly reduce uncertainty and improve value assessment.