TY - JOUR
T1 - Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer
T2 - An Analysis Informed by the proPSMA Trial
AU - de Feria Cardet, Rafael E.
AU - Hofman, Michael S.
AU - Segard, Tatiana
AU - Yim, Jackie
AU - Williams, Scott
AU - Francis, Roslyn J.
AU - Frydenberg, Mark
AU - Lawrentschuk, Nathan
AU - Murphy, Declan G.
AU - De Abreu Lourenco, Richard
PY - 2021/3
Y1 - 2021/3
N2 - Background: Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use. Objective: To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging. Design, setting, and participants: A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or 68Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective. Intervention: 68Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan). Outcome measurements and statistical analysis: The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis. Results and limitations: The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each 68Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care. Conclusions: PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice. Patient summary: The proPSMA study demonstrated that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) better detects disease that has spread beyond the prostate compared with conventional imaging. Our analysis shows that PSMA PET/CT is also less costly than conventional imaging for the detection of disease spread. This research was presented at the European Association of Nuclear Medicine Scientific Meeting in October 2020. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was more effective and less costly compared with conventional imaging in the short term. Over a lifetime horizon, better diagnostic accuracy resulted in more men receiving appropriate treatment, which translated into PSMA PET/CT being cost-effective on the basis of estimated survival and quality-of-life gains.
AB - Background: Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use. Objective: To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging. Design, setting, and participants: A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or 68Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective. Intervention: 68Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan). Outcome measurements and statistical analysis: The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis. Results and limitations: The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each 68Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care. Conclusions: PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice. Patient summary: The proPSMA study demonstrated that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) better detects disease that has spread beyond the prostate compared with conventional imaging. Our analysis shows that PSMA PET/CT is also less costly than conventional imaging for the detection of disease spread. This research was presented at the European Association of Nuclear Medicine Scientific Meeting in October 2020. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was more effective and less costly compared with conventional imaging in the short term. Over a lifetime horizon, better diagnostic accuracy resulted in more men receiving appropriate treatment, which translated into PSMA PET/CT being cost-effective on the basis of estimated survival and quality-of-life gains.
KW - Cost-effectiveness
KW - Economic evaluation
KW - High risk
KW - Positron emission tomography/computed tomography
KW - Prostate cancer
KW - Prostate-specific membrane antigen
KW - Staging
UR - http://www.scopus.com/inward/record.url?scp=85099514680&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2020.11.043
DO - 10.1016/j.eururo.2020.11.043
M3 - Article
C2 - 33341285
AN - SCOPUS:85099514680
SN - 0302-2838
VL - 79
SP - 413
EP - 418
JO - European Urology
JF - European Urology
IS - 3
ER -