Systematic Review Highlights Complexity of Cost-Effectiveness Models in Prostate Cancer

A systematic review highlights the complexity involved in modeling the cost-effectiveness of diagnostic tests in prostate cancer (Value Health. 2022;25[1]:133-146. doi:10.1016/j.jval.2021.07.002).

“Recent innovations in prostate cancer diagnosis include new biomarkers and more accurate biopsy methods. This study assesses the evidence base on cost-effectiveness of these developments… and identifies areas of improvement for future cost-effectiveness models,” wrote Edna Keeney, MSc, Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, England, United Kingdom, and colleagues.

Researchers performed this systematic review using National Health Service Economic Evaluation Database, MEDLINE, Embase, Health Technology Assessment databases, National Institute for Health and Care Excellence guidelines, and United Kingdom National Screening Committee guidance. Relevant data were extracted on study type, model inputs, modeling methods and cost-effectiveness conclusions, and results narratively synthesized.

A total of 22 model-based economic evaluations were included in the review. Of these, 11 compared the cost-effectiveness of new biomarkers to prostate-specific antigen testing alone and found biomarkers to be cost savings. There were 8 evaluations that compared MRI-guided biopsy methods to transrectal ultrasound-guided methods and found MRI-guided methods more cost-effective.

Overall, newer detection methods demonstrated a reduction in unnecessary biopsies and overtreatment. For men with a negative initial biopsy, the most cost-effective follow-up strategy is unknown.

Researchers found that many studies did not model for stage or grade of cancer, cancer progression, or the entire testing and treatment pathways. There were few studies that fully accounted for uncertainty.

“This review brings together the cost-effectiveness literature for novel diagnostic methods in prostate cancer, showing that most studies have found new methods to be more cost-effective than standard of care,” Kenney and colleagues concluded.