Cost-Effectiveness of Prostate Cancer Detection in Biopsy-Naïve Men: Ultrasound Shear Wave Elastography vs. Multiparametric Diagnostic Magnetic Resonance Imaging

Abstract

This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography (SWE) imaging in comparison to pre-biopsy multiparametric magnetic resonance imaging (mpMRI) in men with suspected prostate cancer. This research is motivated by the early evidence of the good performance of SWE in distinguishing cancerous from benign prostate tissues. We used a decision analysis model representing the care-pathways of men referred with a high prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) in a UK setting from the payer’s perspective with results reported in 2016 GBP. We then appraised the cost-effectiveness of a novel approach based on SWE compared to the more conventional and widely practiced mpMRI-based approaches using data reported in the literature. Deterministic and probabilistic sensitivity analyses were used to address uncertainty regarding the parameter values utilised. Our exploratory results implied that SWE approach yielded an additional quality-adjusted life year (QALY) at the cost of GBP 10,048 compared to the standard mpMRI-based approach in the UK. This is lower than the official willingness to pay threshold of GBP 20,000 (the UK healthcare system guidelines) and is therefore a suitable replacement for the current practice. Sensitivity analyses confirmed the robustness of our results.