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Background <p>Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is currently under evaluation for detecting clinically significant prostate cancer. The PSMA-PET/CT may complement the current standard diagnostic pathway for prostate cancer, which includes prostate-specific antigen (PSA) testing and multiparametric magnetic resonance imaging (mpMRI). This study evaluated the cost-effectiveness and quality of life impact of incorporating PSMA-PET/CT into this diagnostic algorithm.</p> Methods <p>A life-time decision model compared the current standard of care of a MRI driven diagnostic pathway, where men undergo prostate biopsy in case of a Prostate Imaging Reporting and Data System (PI-RADS) scores 3–5, to a strategy incorporating PSMA-PET/CT to potentially avoid unnecessary biopsies. Long-term quality-adjusted life years (QALY) and healthcare costs were calculated for each approach.</p> Results <p>In PI-RADS 3 lesions, PSMA-PET/CT improved the per-patient QALY by 0.002 and was borderline cost-effective, with an increased cost of €170-€186 per patient and an incremental cost-effectiveness ratio (ICER) of €56,700-€93,212 per QALY. In PI-RADS 1–2, additional biopsies and over-detection of low-risk prostate cancers led to a per-patient QALY decrease of 0.001 points, a cost increase of €416-€429 per patient and was thus not cost-effective.</p> Conclusion <p>The addition of PSMA-PET/CT to MRI in patients with equivocal MRI findings appears to be borderline cost-effective due to biopsy avoidance and a reduced detection of indolent, low-risk tumors. In men with a negative MRI, adding a PSMA-PET/CT does not seem to be cost-effective due to a higher number of unnecessary biopsies and only minor improvement in the detection of clinically significant prostate cancer.</p>

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A cost-effectiveness study of PSMA-PET/CT for the detection of clinically significant prostate cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月12日

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  • Bastiaan M. Privé,
  • Tim M. Govers,
  • Bas Israël,
  • Marcel J. R. Janssen,
  • Bart J. R. Timmermans,
  • Steffie M. B. Peters,
  • Michel de Groot,
  • Patrik Zámecnik,
  • Stan R. W. Wijn,
  • Alexander Hoepping,
  • J. P. Michiel Sedelaar,
  • Jelle O. Barentsz,
  • Inge M. van Oort,
  • Maarten de Rooij,
  • James Nagarajah

摘要

Background

Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is currently under evaluation for detecting clinically significant prostate cancer. The PSMA-PET/CT may complement the current standard diagnostic pathway for prostate cancer, which includes prostate-specific antigen (PSA) testing and multiparametric magnetic resonance imaging (mpMRI). This study evaluated the cost-effectiveness and quality of life impact of incorporating PSMA-PET/CT into this diagnostic algorithm.

Methods

A life-time decision model compared the current standard of care of a MRI driven diagnostic pathway, where men undergo prostate biopsy in case of a Prostate Imaging Reporting and Data System (PI-RADS) scores 3–5, to a strategy incorporating PSMA-PET/CT to potentially avoid unnecessary biopsies. Long-term quality-adjusted life years (QALY) and healthcare costs were calculated for each approach.

Results

In PI-RADS 3 lesions, PSMA-PET/CT improved the per-patient QALY by 0.002 and was borderline cost-effective, with an increased cost of €170-€186 per patient and an incremental cost-effectiveness ratio (ICER) of €56,700-€93,212 per QALY. In PI-RADS 1–2, additional biopsies and over-detection of low-risk prostate cancers led to a per-patient QALY decrease of 0.001 points, a cost increase of €416-€429 per patient and was thus not cost-effective.

Conclusion

The addition of PSMA-PET/CT to MRI in patients with equivocal MRI findings appears to be borderline cost-effective due to biopsy avoidance and a reduced detection of indolent, low-risk tumors. In men with a negative MRI, adding a PSMA-PET/CT does not seem to be cost-effective due to a higher number of unnecessary biopsies and only minor improvement in the detection of clinically significant prostate cancer.