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Tytuł:
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Cost-Effectiveness of Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study.
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Autorzy:
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Hao S; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Karlsson A; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Heintz E; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Elfström KM; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Nordström T; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Danderyd, Sweden.
Clements M; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: .
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Źródło:
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Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2021 Dec; Vol. 24 (12), pp. 1763-1772. Date of Electronic Publication: 2021 Aug 06.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: Jan./Feb. 2011- : New York : Elsevier
Original Publication: Malden, MA : Blackwell Science, c1998-
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MeSH Terms:
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Cost-Benefit Analysis*
Magnetic Resonance Imaging/*economics
Mass Screening/*economics
Prostatic Neoplasms/*diagnosis
Aged ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; Quality-Adjusted Life Years ; Sweden
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Contributed Indexing:
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Keywords: Sweden; biopsy; cost-effectiveness; magnetic resonance imaging; microsimulation; prostate cancer; screening
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Substance Nomenclature:
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EC 3.4.21.77 (Prostate-Specific Antigen)
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Entry Date(s):
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Date Created: 20211128 Date Completed: 20220103 Latest Revision: 20220103
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Update Code:
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20240104
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DOI:
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10.1016/j.jval.2021.06.001
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PMID:
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34838274
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Objective: This study aimed to assess the cost-effectiveness of magnetic resonance imaging (MRI) with combinations of targeted biopsy (TBx) and systematic biopsy (SBx) for early prostate cancer detection in Sweden.
Methods: A cost-utility analysis was conducted from a lifetime societal perspective using a microsimulation model. Five strategies included no screening and quadrennial screening for men aged 55 to 69 years using SBx alone, TBx on positive MRI (MRI + TBx), combined TBx/SBx on positive MRI (MRI + TBx/SBx), and SBx on negative MRI with TBx/SBx on positive MRI (MRI - SBx, MRI + TBx/SBx). Test characteristics were based on a recent Cochrane review. We predicted the number of biopsies, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios.
Results: The screening strategies were classified in Sweden as high costs per QALY gained compared with no screening. Using MRI + TBx and MRI + TBx/SBx reduced the number of biopsy episodes across a lifetime by approximately 40% compared with SBx alone. Both strategies showed strong dominance over SBx alone and MRI - SBx, MRI + TBx. Compared with MRI + TBx, the MRI + TBx/SBx strategy had an incremental cost-effectiveness ratio of more than €200 000 per QALY gained, which was classified in Sweden as a very high cost. These predictions were robust in the probabilistic sensitivity analysis. Limitations included generalizability of the model assumptions and uncertainty regarding the health-state values and study heterogeneity from the Cochrane review.
Conclusions: MRI + TBx and MRI + TBx/SBx showed strong dominance over alternative screening strategies. MRI + TBx resulted in similar or marginally lower gains in QALYs and lower costs than MRI + TBx/SBx. MRI + TBx was considered the optimal choice among the screening strategies.
(Copyright © 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)
