Screening for prostate cancer with first-line MRI less cost-effective than first-line PSA testing
Abstract: https://www.acpjournals.org/doi/10.7326/M23-1504
Editorial: https://www.acpjournals.org/doi/10.7326/M24-0878
URL goes live when the embargo lifts
Researchers from Fred Hutchinson Cancer Center, Beth Israel Deaconess Medical Center, and the Mayo Clinic developed a microsimulation model to evaluate the comparative effectiveness and cost-effectiveness of first-line bpMRI versus first-line PSA with reflex mpMRI for prostate cancer screening. The authors found that first-line MRI-based screening substantially increased rates of false-positive test results, prostate biopsy, and overdiagnosis without proportionately substantial reductions in prostate cancer mortality. They note that even when assuming no cost for first-line bpMRI screening, first-line PSA testing with reflex mpMRI followed by MRI-guided prostate biopsy with or without transrectal ultrasonography–guided biopsy still resulted in lower costs and better quality of life for patients. These findings suggest that screening efforts should focus on strategies that reduce false-positive results and overdiagnoses to improve cost-effectiveness.
The authors of an accompanying editorial from Vanderbilt University Medical Center suggest that high-quality cost-effectiveness analyses are crucial to understanding the effect of changes in clinical practice on the overall health care system. In addition, these types of analyses provide important economic context that could bolster guidance statements if used in their development, as acknowledged by the National Comprehensive Cancer Network. The authors suggest that other organizations should follow suit by incorporating cost-effectiveness data in their guidelines.
Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author, Roman Gulati, MS, please contact [email protected].
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