25 June 2019

In European Urology Oncology Sejal Patel and colleagues evaluated the potential cost-effectiveness of including mpMRI in active surveillance for men diagnosed with low-risk prostate cancer in comparison to the standard monitoring program comprising of biopsies.


Active surveillance (AS) has limitations that include missing high-risk tumors and performing unnecessary biopsies. The use of multiparametric magnetic resonance imaging (mpMRI) in AS may overcome these limitations, but its cost-effectiveness remains uncertain.
To determine the cost-effectiveness of three AS strategies: AS with transrectal ultrasound-guided biopsy (TRUSGB), AS with mpMRI and MRI ultrasound-guided biopsy (MR-TRUSGB), and AS with mpMRI without biopsies.
Design, setting and participants
A Markov cohort model for men with low-risk prostate cancer was developed to assess the three strategies. Input data were derived from meta-analysis, other published literature, and national cost reports. A health care perspective was used for a European setting.
Outcome measurements and statistical analysis
Health care costs and quality-adjusted life years (QALYs) were modeled over a lifetime horizon. Deterministic and probabilistic sensitivity analyses were performed to address uncertainty in model parameters.
Results and limitations
In the base case analysis, expected mean costs per man screened were €5150 for TRUSGB, €5994 for mpMRI without biopsy, and €4848 for mpMRI with biopsy. Corresponding QALYs were higher for mpMRI with biopsy compared to TRUSGB (18.67 vs 18.66) and lower for mpMRI without biopsy compared to TRUSGB (18.27 vs 18.66). Owing to lower costs and higher effects, the mpMRI with biopsy strategy was cost-effective compared to the TRUSGB strategy.
mpMRI with MR-TRUSGB appears to be the most cost-effective AS strategy for men with low-risk prostate cancer.
Patient summary
We compared costs and quality of life for the standard active surveillance (AS) program for men diagnosed with low-risk prostate cancer to a monitoring program comprising multiparametric magnetic resonance imaging (mpMRI) with and without biopsies. Our results suggest that an AS strategy using mpMRI with biopsy improves quality of life and costs decrease. An AS strategy using mpMRI without biopsy was not beneficial compared to the standard program.

The Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Men with Low-risk Prostate Cancer: A Cost-effectiveness Modeling Study
Patel S, Rongen JJ, Fütterer JJ, Boltyenkov A, Rovers MM.

Sejal Patel is member of theme Urological cancers.

Related news items

Body composition is more important than BMI for renal cancer survival rates

11 January 2022 Body composition is important for survival rates in renal cell cancer. Research from the Radboudumc shows that low muscle quality and low organ fat are associated with poor survival. This involves different stages of renal cancer, ranging from stage I-III to stage IV. read more

Turbo Grants for four medical-technical research projects

19 October 2021 Four TURBO grants were recently awarded to new technical-medical research proposals. The grants are part of the TURBO program, a collaboration between the University of Twente (TechMed Centre) and the Radboudumc. read more

Research into treatment for bladder pain syndrome will now be reimbursed

4 August 2021 Bladder pain syndrome, also called interstitial cystitis, is a chronic benign condition of the urinary bladder read more

Millions of euros for study of laser treatment for glioblastoma

2 April 2021 A research group from Radboudumc and UMC Utrecht is to investigate laser treatment of a rare brain tumor, glioblastoma. 3.9 million euros has been made available for the research by Zorginstituut Nederland and ZonMw, under the auspices of the Subsidy Scheme for Promising Care. read more

Growing consensus in Europe on prostate MRI

4 June 2020 A group of radiologists and urologists has made a new set of recommendations to improve the quality of prostate MRIs. read more

Jurgen Fütterer appointed Professor of Image-Guided Oncological Interventions

26 February 2020 RIHS researcher Fütterer is an interventional radiologist and an expert in the field of cancer imaging techniques, image-guided interventions and robotics. He is also Professor at the Robotics and Mechatronics Group at the University of Twente. read more