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

Author(s): de Feria Cardet, RE; Hofman, MS; Segard, T; Yim, J; Williams, S; Francis, RJ; Frydenberg, M; Lawrentschuk, N; Murphy, DG; De Abreu Lourenco, R;
Details: Publication Year 2021-03,Volume 79,Issue #3,Page 413-418
Journal Title: European Urology
Publication Type: Research article
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 (68)Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective. INTERVENTION: (68)Ga-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 (68)Ga-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.
Keywords: Australia; Cost-Benefit Analysis; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Neoplasm Staging; *Positron Emission Tomography Computed Tomography; Prostate/diagnostic imaging/pathology; *Prostatic Neoplasms/diagnostic imaging/pathology; Cost-effectiveness; Economic evaluation; High risk; Positron emission tomography/computed tomography; Prostate cancer; Prostate-specific membrane antigen; Staging
Department(s): Cancer Imaging; Radiation Oncology; Surgical Oncology
PubMed ID: 33341285
Publisher's Version: https://doi.org/10.1016/j.eururo.2020.11.043
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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