Cost-Effectiveness of Transrectal and Transperineal Prostate Biopsy: Analysis from the ProBE-PC Randomized Study

Cost analyses serve to inform evidence-based decisions for health care utilization while balancing clinical outcomes. Randomized studies have demonstrated minimal differences between transrectal biopsy (TR-Bx) and transperineal prostate biopsy (TP-Bx) for cancer detection and complications. Here, we present a comprehensive analysis of costs associated with TR-Bx and TP-Bx and related health care utilization from the ProBE-PC study.

A total of 718 men completed a randomly assigned TR-Bx or TP-Bx, both under local anesthesia. Cost calculation used modified time-driven activity-based costing, incorporating supplies, personnel time, and postprocedure complication costs. The actual cost or payment (not charges) for each item and encounter at our institution was used for this analysis. Aggregated cost of all complications in a group was averaged over that group. Total cost per procedure included cost of supplies, personnel, and complications.

The procedural cost was significantly higher for TP-Bx compared with TR-Bx ($323.78 vs $124.28; P < .001), driven primarily by higher disposable instrument costs ($198.00 vs $21.67), longer physician time ($84.41 vs $66.06), and nurse time ($24.12 vs $20.10) per procedure. Thirteen participants in each group experienced a complication. The mean cost of complications per biopsy was similar for TP-Bx and TR-Bx ($11.13 vs $19.26; P = .54). The total median cost of procedure plus complications was significantly higher for TP-Bx compared with TR-Bx ($326.78 vs $126.29, P < .005).

TP-Bx under local anesthesia incurs significantly higher overall cost when compared with TR-Bx. These findings are important when selecting biopsy techniques and considering health care utilization in contemporary clinical practice.