title: Cost-effectiveness analysis of multiparametric MRI with increased active surveillance for low-risk prostate cancer in Australia.
abstract: To evaluate the cost-effectiveness of multiparametric magnetic resonance imaging (mpMRI) to diagnose prostate cancer and direct all low-risk patients into active surveillance (AS).
  
  
  
  A Markov cohort model was developed to assess three scenarios: 1) no mpMRI and current AS; 2) mpMRI and current AS; and 3) mpMRI and increased AS. Men were tracked from diagnosis to end-of-life. Estimates to populate the model were derived from systematic reviews, meta-analyses, epidemiological publications, and national cost reports. An Australian Government perspective was used. Outcomes included healthcare costs, survival, quality-adjusted life years (QALYs), number of biopsies, and significant and insignificant cancers. Extensive sensitivity analyses were undertaken to address possible variation in the modeled inputs.
  
  
  
  Mean lifetime costs per patient were AU$23,191 for Scenario 1, AU$23,387 for Scenario 2 and AU$21,064 for Scenario 3. Corresponding QALYs were 7.81, 7.77, 7.83 for Scenarios 1, 2, and 3, respectively. At the current uptake of AS in Australia, mpMRI alone does not appear cost-effective (16.9% likelihood). However, mpMRI with AS for all men with low-risk disease is strongly cost-effective (86.9% likelihood) at a willingness-to-pay AU$50,000 per QALY gained. For the mpMRI options, for every 1000 men suspected of prostate cancer, using mpMRI would avoid 340 biopsies, detect an additional 20 significant cancers, and detect 10 fewer insignificant cancers.
  
  
  
  Diagnosis of prostate cancer through mpMRI technology would be cost-effective if it leads to increased uptake of AS for men with confirmed very-low- or low-risk prostate cancer.
  
  
  
  2 J. MAGN. RESON. IMAGING 2017;45:1304-1315.
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Louisa G
authors.identifier: 0000-0002-3159-4249
authors.initials: LG
authors.lastname: Gordon
authors.affiliation: Griffith University, Centre for Applied Health Economics, Nathan Campus, Brisbane, Australia.
authors.forename: Robbie
authors.initials: R
authors.lastname: James
authors.affiliation: Griffith University, Centre for Applied Health Economics, Nathan Campus, Brisbane, Australia.
authors.forename: Haitham W
authors.initials: HW
authors.lastname: Tuffaha
authors.affiliation: Prostate Cancer Foundation of Australia, St Leonards, Sydney, Australia.|Griffith University, Menzies Health Institute Queensland, Southport, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lowe
authors.affiliation: The Wesley Hospital, Auchenflower, Brisbane, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Yaxley
mesh_terms: D000368:Aged; D001315:Australia; D001706:Biopsy; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D011788:Quality of Life; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: active surveillance; cost-effectiveness; magnetic resonance guided biopsy; multiparametric magnetic resonance imaging; prostate cancer