Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore
Abstract Background To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective. Methods A combined decision tree and M...
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doaj-29e4ecea0c104120a805d7d074d5f31f2021-09-05T11:18:03ZengBMCBMC Health Services Research1472-69632021-09-0121111610.1186/s12913-021-06916-0Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in SingaporeLi-Jen Cheng0Swee Sung Soon1Teck Wei Tan2Cher Heng Tan3Terence Sey Kiat Lim4Kae Jack Tay5Wei Tim Loke6Bertrand Ang7Edmund Chiong8Kwong Ng9Agency for Care Effectiveness, Ministry of Health, SingaporeAgency for Care Effectiveness, Ministry of Health, SingaporeDepartment of Urology, Tan Tock Seng HospitalDepartment of Diagnostic Radiology, Tan Tock Seng HospitalDepartment of Urology, Changi General HospitalDepartment of Urology, Singapore General HospitalUrology Service, Ng Teng Fong General HospitalDepartment of Diagnostic Imaging, National University HospitalDepartment of Urology, National University HospitalAgency for Care Effectiveness, Ministry of Health, SingaporeAbstract Background To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective. Methods A combined decision tree and Markov model was developed. The starting model population was men with mean age of 65 years referred for a first prostate biopsy due to clinical suspicion of prostate cancer. The six diagnostic strategies were selected for their relevance to local clinical practice. They comprised MRI targeted biopsy following a positive pre-biopsy multiparametric MRI (mpMRI) [Prostate Imaging – Reporting and Data System (PI-RADS) score ≥ 3], systematic biopsy, or saturation biopsy employed in different testing combinations and sequences. Deterministic base case analyses with sensitivity analyses were performed using costs from the healthcare system perspective and quality-adjusted life years (QALY) gained as the outcome measure to yield incremental cost-effectiveness ratios (ICERs). Results Deterministic base case analyses showed that Strategy 1 (MRI targeted biopsy alone), Strategy 2 (MRI targeted biopsy ➔ systematic biopsy), and Strategy 4 (MRI targeted biopsy ➔ systematic biopsy ➔ saturation biopsy) were cost-effective options at a willingness-to-pay (WTP) threshold of US$20,000, with ICERs ranging from US$18,975 to US$19,458. Strategies involving MRI targeted biopsy in the repeat biopsy setting were dominated. Sensitivity analyses found the ICERs were affected mostly by changes to the annual discounting rate and prevalence of prostate cancer in men referred for first biopsy, ranging between US$15,755 to US$23,022. Probabilistic sensitivity analyses confirmed Strategy 1 to be the least costly, and Strategies 2 and 4 being the preferred strategies when WTP thresholds were US$20,000 and US$30,000, respectively. Limitations and conclusions This study found MRI targeted biopsy to be cost-effective in diagnosing prostate cancer in the biopsy-naïve setting in Singapore.https://doi.org/10.1186/s12913-021-06916-0 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Li-Jen Cheng Swee Sung Soon Teck Wei Tan Cher Heng Tan Terence Sey Kiat Lim Kae Jack Tay Wei Tim Loke Bertrand Ang Edmund Chiong Kwong Ng |
spellingShingle |
Li-Jen Cheng Swee Sung Soon Teck Wei Tan Cher Heng Tan Terence Sey Kiat Lim Kae Jack Tay Wei Tim Loke Bertrand Ang Edmund Chiong Kwong Ng Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore BMC Health Services Research |
author_facet |
Li-Jen Cheng Swee Sung Soon Teck Wei Tan Cher Heng Tan Terence Sey Kiat Lim Kae Jack Tay Wei Tim Loke Bertrand Ang Edmund Chiong Kwong Ng |
author_sort |
Li-Jen Cheng |
title |
Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore |
title_short |
Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore |
title_full |
Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore |
title_fullStr |
Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore |
title_full_unstemmed |
Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore |
title_sort |
cost-effectiveness of mri targeted biopsy strategies for diagnosing prostate cancer in singapore |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2021-09-01 |
description |
Abstract Background To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective. Methods A combined decision tree and Markov model was developed. The starting model population was men with mean age of 65 years referred for a first prostate biopsy due to clinical suspicion of prostate cancer. The six diagnostic strategies were selected for their relevance to local clinical practice. They comprised MRI targeted biopsy following a positive pre-biopsy multiparametric MRI (mpMRI) [Prostate Imaging – Reporting and Data System (PI-RADS) score ≥ 3], systematic biopsy, or saturation biopsy employed in different testing combinations and sequences. Deterministic base case analyses with sensitivity analyses were performed using costs from the healthcare system perspective and quality-adjusted life years (QALY) gained as the outcome measure to yield incremental cost-effectiveness ratios (ICERs). Results Deterministic base case analyses showed that Strategy 1 (MRI targeted biopsy alone), Strategy 2 (MRI targeted biopsy ➔ systematic biopsy), and Strategy 4 (MRI targeted biopsy ➔ systematic biopsy ➔ saturation biopsy) were cost-effective options at a willingness-to-pay (WTP) threshold of US$20,000, with ICERs ranging from US$18,975 to US$19,458. Strategies involving MRI targeted biopsy in the repeat biopsy setting were dominated. Sensitivity analyses found the ICERs were affected mostly by changes to the annual discounting rate and prevalence of prostate cancer in men referred for first biopsy, ranging between US$15,755 to US$23,022. Probabilistic sensitivity analyses confirmed Strategy 1 to be the least costly, and Strategies 2 and 4 being the preferred strategies when WTP thresholds were US$20,000 and US$30,000, respectively. Limitations and conclusions This study found MRI targeted biopsy to be cost-effective in diagnosing prostate cancer in the biopsy-naïve setting in Singapore. |
url |
https://doi.org/10.1186/s12913-021-06916-0 |
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