PMID- 28514203 OWN - NLM STAT- MEDLINE DCOM- 20171005 LR - 20181113 IS - 1527-1315 (Electronic) IS - 0033-8419 (Print) IS - 0033-8419 (Linking) VI - 285 IP - 1 DP - 2017 Oct TI - Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men. PG - 157-166 LID - 10.1148/radiol.2017162181 [doi] AB - Purpose To evaluate the cost-effectiveness of multiparametric diagnostic magnetic resonance (MR) imaging examination followed by MR imaging-guided biopsy strategies in the detection of prostate cancer in biopsy-naive men presenting with clinical suspicion of cancer for the first time. Materials and Methods A decision-analysis model was created for biopsy-naive men who had been recommended for prostate biopsy on the basis of abnormal digital rectal examination results or elevated prostate-specific antigen levels (age groups: 41-50 years, 51-60 years, and 61-70 years). The following three major strategies were evaluated: (a) standard transrectal ultrasonography (US)-guided biopsy; (b) diagnostic MR imaging followed by MR imaging-targeted biopsy, with no biopsy performed if MR imaging findings were negative; and (c) diagnostic MR imaging followed by MR imaging-targeted biopsy, with a standard biopsy performed when MR imaging findings were negative. The following three MR imaging-guided biopsy strategies were further evaluated in each MR imaging category: (a) biopsy with cognitive guidance, (b) biopsy with MR imaging/US fusion guidance, and (c) in-gantry MR imaging-guided biopsy. Model parameters were derived from the literature. The primary outcome measure was net health benefit (NHB), which was measured as quality-adjusted life-years (QALYs) gained or lost by investing resources in a new strategy compared with a standard strategy at a willingness-to-pay (WTP) threshold of $50 000 per QALY gained. Probabilistic sensitivity analysis was performed by using Monte Carlo simulations. Results Noncontrast MR imaging followed by cognitively guided MR biopsy (no standard biopsy if MR imaging findings were negative) was the most cost-effective approach, yielding an additional NHB of 0.198 QALY compared with the standard biopsy approach. Noncontrast MR imaging followed by in-gantry MR imaging-guided biopsy (no standard biopsy if MR imaging findings were negative) led to the highest NHB gain of 0.251 additional QALY compared with the standard biopsy strategy. All MR imaging strategies were cost-effective in 94.05% of Monte Carlo simulations. Analysis by age groups yielded similar results. Conclusion MR imaging-guided strategies for the detection of prostate cancer were cost-effective compared with the standard biopsy strategy in a decision-analysis model. ((c)) RSNA, 2017 Online supplemental material is available for this article. FAU - Pahwa, Shivani AU - Pahwa S AD - From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.). FAU - Schiltz, Nicholas K AU - Schiltz NK AD - From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.). FAU - Ponsky, Lee E AU - Ponsky LE AD - From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.). FAU - Lu, Ziang AU - Lu Z AD - From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.). FAU - Griswold, Mark A AU - Griswold MA AD - From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.). FAU - Gulani, Vikas AU - Gulani V AD - From the Departments of Radiology (S.P., M.A.G., V.G.) and Urology (L.E.P.), University Hospitals Case Medical Center, 11100 Euclid Ave, Bolwell B120, Cleveland, OH 44106-0500; Department of Epidemiology and Biostatistics (N.K.S.) and Department of Biomedical Engineering (M.A.G., V.G.), Case Western Reserve University, Cleveland, Ohio; and Case Western Reserve University School of Medicine, Cleveland, Ohio (Z.L.). LA - eng GR - KL2 TR000440/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20170517 PL - United States TA - Radiology JT - Radiology JID - 0401260 SB - IM CIN - Radiology. 2017 Dec;285(3):1052-1053. PMID: 29155628 MH - Adult MH - Aged MH - Cost-Benefit Analysis MH - Humans MH - *Image-Guided Biopsy/economics/statistics & numerical data MH - *Magnetic Resonance Imaging/economics/statistics & numerical data MH - Male MH - Middle Aged MH - *Prostatic Neoplasms/diagnostic imaging/economics/pathology PMC - PMC5621719 EDAT- 2017/05/18 06:00 MHDA- 2017/10/06 06:00 PMCR- 2018/10/01 CRDT- 2017/05/18 06:00 PHST- 2017/05/18 06:00 [pubmed] PHST- 2017/10/06 06:00 [medline] PHST- 2017/05/18 06:00 [entrez] PHST- 2018/10/01 00:00 [pmc-release] AID - 10.1148/radiol.2017162181 [doi] PST - ppublish SO - Radiology. 2017 Oct;285(1):157-166. doi: 10.1148/radiol.2017162181. Epub 2017 May 17.