title: [Health-economic evaluation of magnetic resonance imaging before biopsy for diagnosis of prostate cancer].
abstract: OBJECTIVE
  The aim of this study was the health-economic analysis of MR imaging in the diagnostics of suspicious prostate carcinoma (PCa) before execution of a first biopsy.
  
  
  METHODS
  The health-economic analysis included four steps: modeling, determination of probabilities, evaluation, and sensitivity analyses. We performed an effectiveness analysis from the patient perspective as well as a cost-effectiveness and a cost-utility analysis from the health insurance perspective for Austria and Germany. The effectiveness and cost-effectiveness analysis used a hypothetical cohort of 100,000 patients. The result parameters were number of biopsies, number of detected PCa, and monetary costs. For the cost-efficiency analysis, the result parameters, quality-adjusted life years (QALYs) and costs, were calculated for an individual patient.
  
  
  RESULTS
  The efficiency analysis showed that MRI before a first biopsy can prevent ca. 64,000 unnecessary biopsies/ 100,000 patients. The diagnostic efficiency was higher by a factor of 1.7. Due to MRI, eight PCas were additionally detected. From a health insurance perspective, MRI was not cost-effective. Extra costs of ca. 42 m. € per 100,000 patients and of 650 € per prevented biopsy were calculated. The costs per detected PCa were increased by 1395 €. The attainable QALYs were a little higher for the MRI alternative, which was therefore not dominated.
  
  
  CONCLUSIONS
  Our results do not permit a clear recommendation for or against the application of MRI in the diagnostics of PCa. From the patient perspective, it is to be endorsed due to the higher medical efficiency. However, it is connected with higher health insurance costs.
authors.affiliation: Zentrales Institut für Radiologie, Diagnostik und Interventionelle Therapie, Landesklinikum St. Pölten, Osterreich. andi@nmr.at
authors.forename: A
authors.initials: A
authors.lastname: Stadlbauer
authors.forename: R
authors.initials: R
authors.lastname: Bernt
authors.forename: E
authors.initials: E
authors.lastname: Salomonowitz
authors.forename: E
authors.initials: E
authors.lastname: Plas
authors.forename: G
authors.initials: G
authors.lastname: Strunk
authors.forename: K
authors.initials: K
authors.lastname: Eberhardt
mesh_terms: D001317:Austria; D001706:Biopsy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000473:pathology*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000191:economics; D019564:Unnecessary Procedures / Q000191:economics