Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial

Rafael E. de Feria Cardet, Michael S. Hofman, Tatiana Segard, Jackie Yim, Scott Williams, Roslyn J. Francis, Mark Frydenberg, Nathan Lawrentschuk, Declan G. Murphy, Richard De Abreu Lourenco

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)413-418
Number of pages6
JournalEuropean Urology
Volume79
Issue number3
DOIs
Publication statusPublished - Mar 2021

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