JAMA Oncol: Cost-effectiveness ratio for prostate cancer screening with MRI+ biopsy

Prostate-specific antigen (PSA) testing in combination with magnetic resonance imaging (MRI) is rarely used to evaluate
prostate cancer in the context of screening.
The benefits
of MRI followed by a combination of targeted and standard biopsy are reported here.

Based on data from the STHLM3-MRI study, the researchers evaluated the cost-benefit
of using MRI in combination with targeted biopsy and standard biopsy versus standard biopsy alone for prostate cancer screening in Swedish men aged 55-69 years.
Quantities, morbidity, mortality, cost, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER)
were assessed.

Cost-effectiveness ratio of various screening methods

Of the 603 men randomized to the standard group, 165 (27.
4%) did not undergo a standard biopsy; Of the 929 men randomized to the experimental group, 111 (11.
9%) had only MRIs or biopsies
.
Screening strategies were associated with a 6% to 9% reduction in the lifetime risk of prostate cancer-related death compared with
no screening.
The incremental cost-effectiveness ratio of MRI plus biopsy screening is about $53,736, which is classified as moderate cost
in Sweden.
MRI-based screening reduces the number of lifetime biopsies and overdiagnoses by about 50% compared to standard biopsy screening alone, and is highly cost-effective
than traditional PSA screening.

In summary, for prostate cancer screening, this economic evaluation study found that PSA testing followed by MRI, followed by a combination of targeted and standard biopsy, may be more cost-effective
than traditional screening pathways using PSA and standard biopsy.

Original source:

Hao S, Discacciati A, Eklund M, et al.
Cost-effectiveness of Prostate Cancer Screening Using Magnetic Resonance Imaging or Standard Biopsy Based on the STHLM3-MRI Study.
JAMA Oncol.
Published online November 10, 2022.
doi:10.
1001/jamaoncol.
2022.
5252