title: Cost-effectiveness of multiparametric magnetic resonance imaging and targeted biopsy in diagnosing prostate cancer.
abstract: BACKGROUND
  Transrectal ultrasound-guided biopsy (TRUSGB) is the recommended approach to diagnose prostate cancer (PCa). Overdiagnosis and sampling errors represent major limitations. Magnetic resonance imaging (MRI)-targeted biopsy (MRTB) detects higher proportion of significant PCa and reduces diagnosis of insignificant PCa. Costs prevent MRTB from becoming the new standard in PCa diagnosis. The present study aimed at assessing whether added costs of MRI outweigh benefits of MRTB in a cost-utility model.
  
  
  METHODS
  A Markov model was developed to estimate quality-adjusted life-year gained (QALY) and costs for 2 strategies (the standard 12-core TRUSGB strategy and the MRTB strategy) over 5, 10, 15, and 20 years. MRI was used as triage test in biopsy-naive men with clinical suspicion of PCa. The model takes into account probability of men harboring PCa, diagnostic accuracy of both procedures, and probability of being assigned to various treatment options. Direct medical costs based on health care system perspective were included.
  
  
  RESULTS
  Following standard TRUSGB pathway, calculated cumulative effects at 5, 10, 15, and 20 years were 4.25, 7.17, 9.03, and 10.09 QALY, respectively. Cumulative effects in MRTB pathway were 4.29, 7.26, 9.17, and 10.26 QALY, correspondingly. Costs related to TRUSGB strategy were $8,027, $11,406, $14,883, and $17,587 at 5, 10, 15, and 20 years, respectively, as compared with $7,231, $10,450, $13,267, and $15,400 for the MRTB strategy. At 5, 10, 15, and 20 years, MRTB was the established dominant strategy.
  
  
  CONCLUSIONS
  Incorporation of MRI and MRTB in PCa diagnosis and management represents a cost-effective measure at 5, 10, 15, and 20 years after initial diagnosis.
authors.affiliation: Division of Urology, McGill University, Montreal, Canada; Division of Urology, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Cerantola
authors.affiliation: Division of Urology, McGill University, Montreal, Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.affiliation: Division of Urology, McGill University, Montreal, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.affiliation: Division of Urology, McGill University, Montreal, Canada.
authors.forename: Franck
authors.initials: F
authors.lastname: Bladou
authors.affiliation: Division of Urology, McGill University, Montreal, Canada.
authors.forename: Armen
authors.initials: A
authors.lastname: Aprikian
authors.affiliation: Division of Urology, McGill University, Montreal, Canada. Electronic address: wassim.kassouf@muhc.mcgill.ca.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D003362:Cost-Benefit Analysis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D061705:Image-Guided Biopsy / Q000191:economics* / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D009367:Neoplasm Staging; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D019057:Quality-Adjusted Life Years
keywords: Cost-effectiveness; MRI; Prostate cancer; Targeted biopsy