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The prostate: decreasing cost-effectiveness of biopsy with advancing age
R H Gottlieb1, C Mooney, A I Mushlin
1Department of Radiology, University of Rochester Medical Center, New York 14642, USA.
Rationale And Objectives:
The purpose of this study was to determine the cost-effectiveness of prostate biopsy at different excess prostate-specific antigen (PSA) levels as a function of age.
Methods:
Medical decision analysis was performed with standard software (SMLTREE) to determine marginal effectiveness in quality adjusted life years (QALYs) and marginal cost-effectiveness in dollars per QALY of immediate prostate biopsy at different excess PSA levels between 0 ng/mL and 20 ng/mL. The probability of clinically significant cancer with a positive biopsy (pD+Bx+) was assumed to decrease with age from 1.0 at age 50 to 0.2 at age 70. Costs were based on charges at our hospital and were considered over a 2-year time frame.
Results:
With our base case assumptions there was a decrease in QALYs and an increase in costs doing an immediate prostate biopsy at all excess PSA levels between 0 ng/mL and 20 ng/mL, compared with not biopsying the prostate at > or = 70 years. Doubling pD+Bx+ from 0.2 to 0.4 in the 70-and-older age group resulted in a small increase in QALYs in biopsying the prostate at excess PSA levels between 0 ng/mL and 20 ng/mL. However, the marginal cost-effectiveness of prostate biopsy was very high, ranging from $275,000/QALY biopsying at an excess PSA level of 0 ng/mL to $68,000/QALY biopsying at an excess PSA level of 20 ng/mL. This compared with it being more effective and less costly to biopsy at all excess PSA levels > or = 0 ng/mL in 50-year old patients.
Conclusion:
Immediate prostate biopsy is not cost-effective and can be detrimental in patients > or = 70 years of age at all excess PSA levels between 0 ng/mL and 20 ng/mL.