title: Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion.
abstract: OBJECTIVE
  Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective.
  
  
  METHODS
  A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed.
  
  
  RESULTS
  The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective.
  
  
  CONCLUSIONS
  Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.
authors.affiliation: 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Wulphert
authors.initials: W
authors.lastname: Venderink
authors.affiliation: 2 Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Tim M
authors.initials: TM
authors.lastname: Govers
authors.affiliation: 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: de Rooij
authors.affiliation: 1 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.affiliation: 3 Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J P Michiel
authors.initials: JPM
authors.lastname: Sedelaar
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D061705:Image-Guided Biopsy / Q000191:economics* / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000191:economics / Q000379:methods*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D019057:Quality-Adjusted Life Years; D018084:Ultrasonography, Interventional / Q000191:economics / Q000379:methods*
keywords: MRI; biopsy; cost-effectiveness; prostate cancer