dc.contributor.author | Merriel, SWD | |
dc.contributor.author | Buttle, P | |
dc.contributor.author | Price, SJ | |
dc.contributor.author | Burns-Cox, N | |
dc.contributor.author | Walter, FM | |
dc.contributor.author | Hamilton, W | |
dc.contributor.author | Spencer, AE | |
dc.date.accessioned | 2024-07-02T13:25:07Z | |
dc.date.issued | 2024 | |
dc.date.updated | 2024-07-02T10:29:58Z | |
dc.description.abstract | To explore the potential impacts of incorporating pre-biopsy magnetic
resonance imaging into primary care as a triage test within the prostate cancer
diagnostic pathway.
Subjects and methods
Decision analytic modelling with decision trees was utilised for this early
economic evaluation. A conceptual model was developed reflecting the
common primary care routes to diagnosis for prostate cancer; opportunistic,
asymptomatic Prostate Specific Antigen (PSA) screening or symptomatic
presentation. The use of multiparametric MRI (mpMRI) or biparametric MRI
(bpMRI) as a primary care triage test following an elevated PSA result was
evaluated. A health system perspective was adopted with a time horizon of 12
months. Health effects were expressed in terms of utilities drawn from the
literature. The primary outcome was prostate cancer diagnosis. Evidence used
to inform the model was drawn from published primary studies, systematic
reviews, and secondary analyses of primary and secondary care datasets.
Results
Base-case analysis showed that the PSA pathway was dominated by both
mpMRI- and bpMRI-based pathways for patients undergoing opportunistic
screening and symptomatic assessment. bpMRI pathways had greater
improvement in cost and utility than mpMRI pathways in both clinical scenarios.
Significantly more MRI scans would be performed using the modelled approach
(66,626 scans vs 37,456 scans per 100,000 patients per annum), with fewer
subsequent urgent suspected cancer referrals for both mpMRI (38% reduction
for screening and symptomatic patients) and bpMRI (72% reduction for
screening; 71% for symptomatic) pathways, and a small increase in number of
missed cancer diagnoses. Deterministic sensitivity analyses, varying each
parameter to its upper and lower 95% confidence intervals, showed no
significant change in the dominance of the MRI-based prostate cancer
diagnostic pathways.
Conclusion
Using prostate MRI as a second-level triage test for suspected prostate cancer
in primary care could reduce health service costs without a detrimental effect on
patient utility | en_GB |
dc.description.sponsorship | Cancer Research UK | en_GB |
dc.identifier.citation | Awaiting citation and DOI | en_GB |
dc.identifier.grantnumber | C8640/A23385 | en_GB |
dc.identifier.grantnumber | C56843/A21550 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/136540 | |
dc.identifier | ORCID: 0000-0002-8163-3103 (Spencer, Anne) | |
dc.language.iso | en | en_GB |
dc.publisher | Wiley | en_GB |
dc.rights.embargoreason | Under temporary indefinite embargo pending publication by Wiley. No embargo required on publication. AAM to be replaced with published version on publication | en_GB |
dc.subject | Prostate cancer | en_GB |
dc.subject | diagnosis | en_GB |
dc.subject | primary care | en_GB |
dc.subject | mpMRI | en_GB |
dc.subject | bpMRI | en_GB |
dc.subject | early economic evaluation | en_GB |
dc.title | Early economic evaluation of magnetic resonance imaging for prostate cancer detection in primary care | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2024-07-02T13:25:07Z | |
dc.description | This is the author accepted manuscript. | en_GB |
dc.description | Data availability statement: Data used for this model from published papers are freely available to access. CPRD data from the CRUK IMPACT study and South-West Peninsula Cancer Alliance Prostate Cancer Dashboard data are not publicly available; any requests for access should be made to SJP and NBC respectively | en_GB |
dc.identifier.eissn | 2688-4526 | |
dc.identifier.journal | BJUI Compass | en_GB |
dc.relation.ispartof | BJUI Compass | |
dc.rights.uri | http://www.rioxx.net/licenses/all-rights-reserved | en_GB |
dcterms.dateAccepted | 2024-06-18 | |
dcterms.dateSubmitted | 2024-06-25 | |
rioxxterms.version | AM | en_GB |
rioxxterms.licenseref.startdate | 2024-06-18 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2024-07-02T10:30:01Z | |
refterms.versionFCD | P | |
refterms.panel | A | en_GB |
exeter.rights-retention-statement | No | |