Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective.BACKGROUND
 The current diagnostic strategy using transrectal ultrasound-guided biopsy (TRUSGB) raises concerns regarding overdiagnosis and overtreatment of prostate cancer (PCa).  Interest in integrating multiparametric magnetic resonance imaging (MRI) and magnetic resonance-guided biopsy (MRGB) into the diagnostic pathway to reduce overdiagnosis and improve grading is gaining ground, but it remains uncertain whether this image-based strategy is cost-effective.


 OBJECTIVE
 To determine the cost-effectiveness of multiparametric MRI and MRGB compared with TRUSGB.


 DESIGN, SETTING, AND PARTICIPANTS
 A combined decision tree and Markov model for men with elevated prostate-specific antigen (>4 ng/ml) was developed.  Input data were derived from systematic literature searches, meta-analyses, and expert opinion.


 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
 Quality-adjusted life years (QALYs) and health care costs of both strategies were modelled over 10 yr after initial suspicion of PCa.  Probabilistic and threshold analyses were performed to assess uncertainty.


 Despite uncertainty around the presented cost-effectiveness estimates, our results suggest that the MRI strategy is cost-effective compared with the standard of care.  Expected costs per patient were € 2423 for the MRI strategy and € 2392 for the TRUSGB strategy.  Corresponding QALYs were higher for the MRI strategy (7.00 versus 6.90), resulting in an incremental cost-effectiveness ratio of € 323 per QALY.  Threshold analysis revealed that MRI is cost-effective when sensitivity of MRGB is ≥ 20%.  The probability that the MRI strategy is cost-effective is around 80% at willingness to pay thresholds higher than € 2000 per QALY.


 CONCLUSIONS
 Total costs of the MRI strategy are almost equal with the standard of care, while reduction of overdiagnosis and overtreatment with the MRI strategy leads to an improvement in quality of life.


 We compared costs and quality of life (QoL) of the standard "blind" diagnostic technique with an image-based technique for men with suspicion of prostate cancer.  Our results suggest that costs were comparable, with higher QoL for the image-based technique.
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