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Cost‐effectiveness of a new urinary biomarker‐based risk score compared to standard of care in prostate cancer diagnostics – a decision analytical model
Author(s) -
Dijkstra Siebren,
Govers Tim M.,
Hendriks Rianne J.,
Schalken Jack A.,
Van Criekinge Wim,
Van Neste Leander,
Grutters Janneke P.C.,
Sedelaar John P. Michiel,
Oort Inge M.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13861
Subject(s) - medicine , prostate cancer , cost effectiveness , transrectal ultrasonography , quality adjusted life year , prostate , biopsy , cancer , urology , risk analysis (engineering)
Objective To assess the cost‐effectiveness of a new urinary biomarker‐based risk score (Select MD x; MD xHealth, Inc., Irvine, CA , USA ) to identify patients for transrectal ultrasonography ( TRUS )‐guided biopsy and to compare this with the current standard of care ( SOC ), using only prostate‐specific antigen ( PSA ) to select for TRUS ‐guided biopsy. Materials and Methods A decision tree and Markov model were developed to evaluate the cost‐effectiveness of Select MD x as a reflex test vs SOC in men with a PSA level of >3 ng/ mL . Transition probabilities, utilities and costs were derived from the literature and expert opinion. Cost‐effectiveness was expressed in quality‐adjusted life years ( QALY s) and healthcare costs of both diagnostic strategies, simulating the course of patients over a time horizon representing 18 years. Deterministic sensitivity analyses were performed to address uncertainty in assumptions. Results A diagnostic strategy including Select MD x with a cut‐off chosen at a sensitivity of 95.7% for high‐grade prostate cancer resulted in savings of €128 and a gain of 0.025 QALY per patient compared to the SOC strategy. The sensitivity analyses showed that the disutility assigned to active surveillance had a high impact on the QALY s gained and the disutility attributed to TRUS ‐guided biopsy only slightly influenced the outcome of the model. Conclusion Based on the currently available evidence, the reduction of over diagnosis and overtreatment due to the use of the Select MD x test in men with PSA levels of >3 ng/ mL may lead to a reduction in total costs per patient and a gain in QALY s.