Economic evaluation of diagnostic localization following biochemical prostate cancer recurrence.
OBJECTIVE
The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy.


METHODS
Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care-using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare.


RESULTS
The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24-2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330-44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947-22,372). RESULTS were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity.


CONCLUSIONS
This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.
Vanderbilt University Medical Center.
Daniel A
DA
Barocas
Fred Hutchinson Cancer Research Center.
Mark E
ME
Bensink
Fred Hutchinson Cancer Research Center.
Kristin
K
Berry
Fred Hutchinson Cancer Research Center.
Zahra
Z
Musa
GE Healthcare.
Carolyn
C
Bodnar
GE Healthcare.
Robert
R
Dann
Fred Hutchinson Cancer Research Centersramsey@fhcrc.org.
Scott D
SD
Ramsey
D000368:Aged; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D057054:Molecular Imaging / Q000191:economics*; D009362:Neoplasm Metastasis / Q000175:diagnosis; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D019057:Quality-Adjusted Life Years; D011859:Radiography; D012680:Sensitivity and Specificity; D013673:Technology Assessment, Biomedical
D017430:Prostate-Specific Antigen
Economic