Mp57-08 Cost Effectiveness of Prostate Specific Membrane Antigen Positron Emission Tomography (Psma-Pet) for the Evaluation of Biochemical Recurrent Prostate Cancer in the United States Healthcare System

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57) 1 May 2024MP57-08 COST EFFECTIVENESS OF PROSTATE SPECIFIC MEMBRANE ANTIGEN POSITRON EMISSION TOMOGRAPHY (PSMA-PET) FOR THE EVALUATION OF BIOCHEMICAL RECURRENT PROSTATE CANCER IN THE UNITED STATES HEALTHCARE SYSTEM Natalia Kunst, Jessica B. Long, Sarah Westvold, Preston Sprenkle, Maximilian Rabil, Umar Ghaffar, Isaac Y. Kim, Lawrence Saperstein, Shi-Yi Wang, Xiaomei Ma, Cary P. Gross, and Michael S. Leapman Natalia KunstNatalia Kunst, Jessica B. LongJessica B. Long, Sarah WestvoldSarah Westvold, Preston SprenklePreston Sprenkle, Maximilian RabilMaximilian Rabil, Umar GhaffarUmar Ghaffar, Isaac Y. KimIsaac Y. Kim, Lawrence SapersteinLawrence Saperstein, Shi-Yi WangShi-Yi Wang, Xiaomei MaXiaomei Ma, Cary P. GrossCary P. Gross, and Michael S. LeapmanMichael S. Leapman View All Author Informationhttps: //doi. org/10. 1097/01. JU. 0001009420. 83948. eb. 08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: More sensitive forms of prostate cancer imaging such as prostate specific membrane antigen positron emission tomography (PSMA-PET) may impact both patient outcomes and healthcare expenditures. To date, long-term cost effectiveness associated with incorporating PSMA-PET into clinical practice has not been evaluated from the United States (U. S. ) healthcare perspective. METHODS: We developed a decision-analytic model consisting of a decision tree and a Markov model to evaluate the cost-effectiveness of three distinct imaging strategies for the evaluation of patients with biochemical recurrence (BCR) following initial treatment with radical prostatectomy or radiation therapy. These included: 1) immediate PSMA-PET imaging, 2) conventional imaging (CT and bone scan; CTBS) followed by PSMA-PET if CTBS is negative or equivocal (CTBS+PSMA-PET), and 3) CTBS alone. The simulated outcomes included lifetime prostate cancer costs (imagining and treatment; US dollar) and quality-adjusted life years (QALYs) associated with each strategy considered. The input parameters were derived from literature and analyses of real-world clinical practice from two institutions. We identify the cost-effective intervention based on incremental cost effectiveness ratios (ICERs), which were defined as the incremental cost per quality-adjusted life year (QALY) gained and assumed a willingness-to-pay threshold of 100, 000/QALY. We further stratified patients by their PSA level (0-1. 99, 2-4. 99, ≥5 ng/mL) and evaluated cost-effectiveness of the imaging strategies within these strata. RESULTS: For the base-case scenario of a patient with BCR, the estimated expected lifetime costs were 457, 242 (95% uncertainty interval (UI) 344, 969-590, 488) for PSMA PET, 464, 992 (95% UI 351, 604-599, 709) for CTBS+PSMA, and 398, 062 (95% UI 304, 956-509, 806) for CTBS alone. Compared to CTBS alone, PSMA-PET was cost-effective across all PSA strata, with an ICER of 85, 641/QALY. CTBS+PSMA-PET was strongly dominated. While PSMA-PET led to the highest cost and QALY across PSA categories, the ICER of PSMA-PET decreased with PSA level. ICER estimates were 39, 730/QALY for PSA 0-1. 99, 106, 003/QALY for PSA 2-4. 99, and 144, 229/QALY for PSA>5 ng/mL. CONCLUSIONS: This economic evaluation suggests that upfront PSMA-PET imaging is the cost-effective diagnostic strategy for the evaluation of biochemical recurrent prostate cancer from the U. S. healthcare perspective. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc. FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e940 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc. Metrics Author Information Natalia Kunst More articles by this author Jessica B. Long More articles by this author Sarah Westvold More articles by this author Preston Sprenkle More articles by this author Maximilian Rabil More articles by this author Umar Ghaffar More articles by this author Isaac Y. Kim More articles by this author Lawrence Saperstein More articles by this author Shi-Yi Wang More articles by this author Xiaomei Ma More articles by this author Cary P. Gross More articles by this author Michael S. Leapman More articles by this author Expand All Advertisement PDF downloadLoading. . .