Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial.

de Feria Cardet, RE; Hofman, MS; Segard, T; Yim, J; Williams, S; Francis, RJ; Frydenberg, M; Lawrentschuk, N; Murphy, DG; De Abreu Lourenco, R

Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial.

de Feria Cardet, RE Hofman, MS Segard, T Yim, J Williams, S Francis, RJ Frydenberg, M Lawrentschuk, N Murphy, DG De Abreu Lourenco, R

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: European urology, 2020
Issue Date:: 2020-12-16

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Field	Value	Language
dc.contributor.author	de Feria Cardet, RE
dc.contributor.author	Hofman, MS
dc.contributor.author	Segard, T
dc.contributor.author	Yim, J
dc.contributor.author	Williams, S
dc.contributor.author	Francis, RJ
dc.contributor.author	Frydenberg, M
dc.contributor.author	Lawrentschuk, N
dc.contributor.author	Murphy, DG
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774
dc.date.accessioned	2021-02-04T01:42:00Z
dc.date.available	2020-11-28
dc.date.available	2021-02-04T01:42:00Z
dc.date.issued	2020-12-16
dc.identifier.citation	European urology, 2020
dc.identifier.issn	0302-2838
dc.identifier.issn	1873-7560
dc.identifier.uri	http://hdl.handle.net/10453/145794
dc.description.abstract	<h4>Background</h4>Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use.<h4>Objective</h4>To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging.<h4>Design, setting, and participants</h4>A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or <sup>68</sup>Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective.<h4>Intervention</h4><sup>68</sup>Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan).<h4>Outcome measurements and statistical analysis</h4>The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis.<h4>Results and limitations</h4>The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each <sup>68</sup>Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care.<h4>Conclusions</h4>PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice.<h4>Patient summary</h4>The proPSMA study demonstrated that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) better detects disease that has spread beyond the prostate compared with conventional imaging. Our analysis shows that PSMA PET/CT is also less costly than conventional imaging for the detection of disease spread. This research was presented at the European Association of Nuclear Medicine Scientific Meeting in October 2020.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	European urology
dc.relation.isbasedon	10.1016/j.eururo.2020.11.043
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences
dc.subject.classification	Urology & Nephrology
dc.title	Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial.
dc.type	Journal Article
utslib.location.activity	Switzerland
utslib.for	1103 Clinical Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
dc.date.updated	2021-02-04T01:41:56Z
pubs.publication-status	Published

Abstract:

Background

Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use.

Objective

To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging.

Design, setting, and participants

A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or ⁶⁸Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective.

Intervention

⁶⁸Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan).

Outcome measurements and statistical analysis

The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis.

Results and limitations

The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each ⁶⁸Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care.

Conclusions

PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice.

Patient summary

The proPSMA study demonstrated that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) better detects disease that has spread beyond the prostate compared with conventional imaging. Our analysis shows that PSMA PET/CT is also less costly than conventional imaging for the detection of disease spread. This research was presented at the European Association of Nuclear Medicine Scientific Meeting in October 2020.

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http://hdl.handle.net/10453/145794