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ECONOMIC EVALUATION OF DIAGNOSTIC LOCALIZATION FOLLOWING BIOCHEMICAL PROSTATE CANCER RECURRENCE

Published online by Cambridge University Press:  17 November 2014

Daniel A. Barocas ,
Mark E. Bensink ,
Kristin Berry ,
Zahra Musa ,
Carolyn Bodnar ,
Robert Dann  and
Scott D. Ramsey
Daniel A. Barocas
Affiliation:
Vanderbilt University Medical Center
Mark E. Bensink
Affiliation:
Fred Hutchinson Cancer Research Center
Kristin Berry
Affiliation:
Fred Hutchinson Cancer Research Center
Zahra Musa
Affiliation:
Fred Hutchinson Cancer Research Center
Carolyn Bodnar
Affiliation:
GE Healthcare
Robert Dann
Affiliation:
GE Healthcare
Scott D. Ramsey
Affiliation:
Fred Hutchinson Cancer Research Centersramsey@fhcrc.org
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Abstract

Objectives: The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy.

Methods: Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care—using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare.

Results: The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24–2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330–44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947–22,372). Results were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity.

Conclusion: This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.

Keywords

Prostate neoplasmsNeoplasm recurrenceLocalNeoplasm metastasisMolecular imagingModelsEconomic
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 4 , October 2014 , pp. 345 - 353
Copyright
Copyright © Cambridge University Press 2014 

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