• Turner, Emma
• Martin, Richard
• Thom, Howard
• Keeney, Edna
• Sanghera, Sabina
• Morley, Josie E.

Abstract

Objectives<br/>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 (e.g. Prostate Health Index (PHI) and MRI-guided biopsy) and identifies areas of improvement for future cost-effectiveness models. <br/>Methods <br/>A systematic review using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2021. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions, and results narratively synthesized.<br/>Results <br/>22 model-based economic evaluations were included. Eleven compared the cost-effectiveness of new biomarkers to PSA testing alone and all found biomarkers to be cost saving. Eight compared MRI-guided biopsy methods to TRUS guided and found MRI-guided methods to be most cost-effective. Newer detection methods showed a reduction in unnecessary biopsies and overtreatment. The most cost-effective follow-up strategy in men with a negative initial biopsy was uncertain. Many studies did not model for stage or grade of cancer, cancer progression or the entire testing and treatment pathway. Few fully accounted for uncertainty.<br/>Conclusions <br/>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. Several limitations of the models were identified, however, limiting reliability of the results. Areas for further development include accurately modelling the impact of early diagnostic tests on long-term outcomes of prostate cancer and fully accounting for uncertainty.

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