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18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 2. Cost-Effectiveness Analysis.
The Journal of Nuclear Medicine ( IF 9.3 ) Pub Date : 2019-12-01 , DOI: 10.2967/jnumed.119.225771
Christine L Barnett 1, 2 , Matthew S Davenport 3, 4 , Jeffrey S Montgomery 4 , Lakshmi Priya Kunju 5 , Brian T Denton 2, 4 , Morand Piert 6
Affiliation  

The objective of this study was to evaluate the cost-effectiveness of 18F-choline PET/multiparametric MRI (mpMRI) versus mpMRI alone for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 in men with elevated prostate-specific antigen levels. Methods: A Markov model of prostate cancer onset and progression was used to estimate the health and economic consequences of 18F-choline PET/mpMRI for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 in men with elevated prostate-specific antigen levels. Multiple simultaneous hybrid 18F-choline PET/mpMRI strategies were evaluated using Likert or Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scoring; the first was biopsy for Likert 5 mpMRI lesions or Likert 3–4 lesions with 18F-choline target-to-background ratios of greater than or equal to 1.58, and the second was biopsy for PI-RADSv2 5 mpMRI lesions or PI-RADSv2 3–4 mpMRI lesions with 18F-choline target-to-background ratios of greater than or equal to 1.58. These strategies were compared with universal standard biopsy, mpMRI alone with biopsy only for PI-RADSv2 3–5 lesions, and mpMRI alone with biopsy only for Likert 4–5 lesions. For each mpMRI strategy, either no biopsy or standard biopsy could be performed after negative mpMRI results were obtained. Deaths averted, quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios were estimated for each strategy. Results: When the results of 18F-choline PET/mpMRI were negative, performing a standard biopsy was more expensive and had lower QALYs than performing no biopsy. The best screening strategy among those considered in this study performed hybrid 18F-choline PET/mpMRI with Likert scoring on men with elevated PSA, performed combined biopsy (targeted biopsy and standard 12-core biopsy) for men with positive imaging results, and no biopsy for men with negative imaging results ($22,706/QALY gained relative to mpMRI alone); this strategy reduced the number of biopsies by 35% in comparison to mpMRI alone. When the same policies were compared using PI-RADSv2 instead of Likert scoring, hybrid 18F-choline PET/mpMRI cost $46,867/QALY gained relative to mpMRI alone. In a threshold analysis, the best strategy among those considered remained cost-effective when the sensitivity and specificity of PET/mpMRI and combined biopsy (targeted biopsy and standard 12-core biopsy) were simultaneously reduced by 20 percentage points. Conclusion: 18F-choline PET/mpMRI for the detection of primary prostate cancer with a Gleason score of greater than or equal to 3 + 4 is cost-effective and can reduce the number of unneeded biopsies in comparison to mpMRI alone.



中文翻译:

用于临床意义上的前列腺癌检测的18F-胆碱PET / mpMRI:第2部分。成本-效果分析。

这项研究的目的是评估18 F-胆碱PET /多参数MRI(mpMRI)与仅mpMRI相比在患有以下疾病的男性中检测Gleason评分大于或等于3 + 4的原发性前列腺癌的成本效益。前列腺特异性抗原水平升高。方法:使用马尔可夫模型对前列腺癌的发作和进展进行评估,以评估18 F-胆碱PET / mpMRI对男性原发性前列腺癌的Gleason评分大于或等于3 + 4的健康和经济影响前列腺特异性抗原水平升高。多个同时混合动力18使用Likert或前列腺成像报告和数据系统版本2(PI-RADSv2)评分评估F-胆碱PET / mpMRI策略;第一个是对Likert 5 mpMRI病变或Likert 3–4病变进行活检,其18 F-胆碱靶与背景之比大于或等于1.58,第二个是对PI-RADSv2 5 mpMRI病变或PI-RADSv2进行活检。 3-4例mpMRI病变,其中18例F-胆碱目标与背景之比大于或等于1.58。将这些策略与通用标准活检,仅针对pi-radsv2 3–5病变的mpMRI单独进行活检和仅针对李克特4–5病变的单独mpMRI进行了比较。对于每种mpMRI策略,在获得mpMRI阴性结果后均无法进行活检或标准活检。每种策略都可以估算避免死亡的人数,质量调整生命年(QALYs),成本和成本效益比。结果:18 F-胆碱PET / mpMRI的结果为阴性时,与不进行活检相比,进行标准活检更昂贵且QALY更低。在这项研究中考虑的最佳筛选策略中,采用杂交18F-胆碱PET / mpMRI对PSA升高的男性进行Likert评分,对影像学阳性的男性进行联合活检(靶向活检和标准12芯活检),而对影像学阴性的男性则不进行活检(相对增加$ 22,706 / QALY仅用于mpMRI);与仅使用mpMRI相比,该策略可将活检数量减少35%。当使用PI-RADSv2而不是Likert评分对相同的政策进行比较时,相对于单独的mpMRI ,混合18 F-胆碱PET / mpMRI的成本为$ 46,867 / QALY。在阈值分析中,当PET / mpMRI和联合活检(靶向活检和标准12芯活检)的敏感性和特异性同时降低20个百分点时,被认为是最佳的策略仍然具有成本效益。结论: 18F-胆碱PET / mpMRI用于检测原发性前列腺癌,其Gleason评分大于或等于3 + 4,具有成本效益,并且与单独的mpMRI相比,可以减少不必要的活检次数。

更新日期:2019-12-02
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