Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results

Prostate cancer (PCa) is the most common non-cutaneous cancer among men in the US and the second-highest cause of cancer deaths among men. The standard for detecting PCa is transrectal ultrasonography, often associated with post-biopsy complications and limited diagnostic accuracy. It is also performed without visual confirmation of the cancer’s location. Magnetic resonance imaging (MRI) is an alternative to the procedure that has proven efficacy but has not previously been evaluated for cost-effectiveness.  

In a new study in JAMA Network Open, Hyunkyung Yun, a graduate of the MS in Health Policy and Economics program at Weill Cornell Medicine and current PhD student at Brown University, Dr. Ali Jalali, assistant professor of population health sciences, Dr. Bruce Schackman, Saul P. Steinberg distinguished professor of population health sciences and director of the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), and colleagues explore the cost-effectiveness of annual MRI and potential MRI-guided biopsy as a screening strategy for PCa detection compared with standard biopsy.  

To complete the study, researchers used a Markov model, or a model representing pseudo-randomly changing systems. Researchers utilized simulated data to evaluate the cost and effectiveness of both procedures for newly eligible male Medicare recipients at age 65 over ten years. The population also had a positive prostate-specific antigen (PSA) test result level of 2.5 ng/mL or more, this being a potential indicator of prostate cancer.    

Results suggest that the MRI and potential MRI-guided biopsy strategy is cost-effective compared with standard biopsy for detecting PCa among the specified population from a federal payer perspective. Given that multiparametric MRI can assess which men have regions suspicious for cancer in the prostate, these findings indicate that men in the US can receive the procedures while improving the detection of clinically significant cancer and potentially avoiding biopsy 

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