Abstract
Objectives
Recent innovations in prostate cancer diagnosis include new biomarkers and more accurate biopsy methods. This study assesses the evidence base on cost-effectiveness of these developments (e.g. Prostate Health Index (PHI) and MRI-guided biopsy) and identifies areas of improvement for future cost-effectiveness models.
Methods
A systematic review using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2021. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions, and results narratively synthesized.
Results
22 model-based economic evaluations were included. Eleven compared the cost-effectiveness of new biomarkers to PSA testing alone and all found biomarkers to be cost saving. Eight compared MRI-guided biopsy methods to TRUS guided and found MRI-guided methods to be most cost-effective. Newer detection methods showed a reduction in unnecessary biopsies and overtreatment. The most cost-effective follow-up strategy in men with a negative initial biopsy was uncertain. Many studies did not model for stage or grade of cancer, cancer progression or the entire testing and treatment pathway. Few fully accounted for uncertainty.
Conclusions
This review brings together the cost-effectiveness literature for novel diagnostic methods in prostate cancer, showing that most studies have found new methods to be more cost-effective than standard of care. Several limitations of the models were identified, however, limiting reliability of the results. Areas for further development include accurately modelling the impact of early diagnostic tests on long-term outcomes of prostate cancer and fully accounting for uncertainty.
Recent innovations in prostate cancer diagnosis include new biomarkers and more accurate biopsy methods. This study assesses the evidence base on cost-effectiveness of these developments (e.g. Prostate Health Index (PHI) and MRI-guided biopsy) and identifies areas of improvement for future cost-effectiveness models.
Methods
A systematic review using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2021. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions, and results narratively synthesized.
Results
22 model-based economic evaluations were included. Eleven compared the cost-effectiveness of new biomarkers to PSA testing alone and all found biomarkers to be cost saving. Eight compared MRI-guided biopsy methods to TRUS guided and found MRI-guided methods to be most cost-effective. Newer detection methods showed a reduction in unnecessary biopsies and overtreatment. The most cost-effective follow-up strategy in men with a negative initial biopsy was uncertain. Many studies did not model for stage or grade of cancer, cancer progression or the entire testing and treatment pathway. Few fully accounted for uncertainty.
Conclusions
This review brings together the cost-effectiveness literature for novel diagnostic methods in prostate cancer, showing that most studies have found new methods to be more cost-effective than standard of care. Several limitations of the models were identified, however, limiting reliability of the results. Areas for further development include accurately modelling the impact of early diagnostic tests on long-term outcomes of prostate cancer and fully accounting for uncertainty.
| Original language | English |
|---|---|
| Pages (from-to) | 133-146 |
| Number of pages | 14 |
| Journal | Value in Health |
| Volume | 25 |
| Issue number | 1 |
| Early online date | 22 Sept 2021 |
| DOIs | |
| Publication status | Published - 11 Jan 2022 |
Bibliographical note
Funding Information:Funding/Support: Cancer Research UK and the United Kingdom Department of Health (C11043/A4286, C18281/A8145, C18281/A11326, C18281/A15064, and C18281/A24432). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the United Kingdom National Institute for Health Research or the Department of Health and Social Care.
Funding Information:
Conflict of Interest Disclosures: Ms Keeney and Dr Thom reported performing commercial consulting for Novartis Pharma AG, Roche, Pfizer Inc, and Bristol-Myers Squibb outside the submitted work. Dr Thom reported performing commercial consulting for Janssen outside the submitted work and receiving a covered university salary from the National Institute for Health Research Biomedical Research Centre at University Hospitals Bristol NHS Foundation outside the submitted work. Dr Martin reported receiving grants from Cancer Research UK to evaluate the long-term effectiveness and cost-effectiveness of population-based screening and treatment for prostate cancer: the CAP and ProtecT randomized controlled trials, during the conduct of the study, and being supported by the National Institute for Health Research Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol outside the submitted work. Dr Turner reported receiving a grant from Cancer Research UK during the course of this study. No other disclosures were reported.
Publisher Copyright:
© 2021 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.
Research Groups and Themes
- HEHP@Bristol
Keywords
- cost-effectiveness models
- diagnosis
- prostate cancer
- systematic review
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