Cost consideration in utilization of multiparametric magnetic resonance imaging in prostate cancer

Abstract

The screening, evaluation and management of prostate cancer changed significantly in the last decade. The recommendations regarding prostate cancer screening continue to evolve with new revelations about existing data sets and longer followup of landmark trials. Robotics has gained the vast majority of the marketplace for surgically managed prostate cancer in rapid fashion. The need for intervention in low risk prostate cancer has been closely examined and more men are being expectantly managed than ever before. Amidst all these changes, prostate magnetic resonance imaging (MRI) has emerged as a disruptive technology. Through the use of dynamic contrast-enhanced and diffusion weighted series, prostate tumors that were previously not visible have become identifiable and quantifiable. The ability of MRI to improve staging and identification of clinically significant disease has resulted in increased utilization for different aspects of prostate cancer care. The best studied use is in men with a prior negative transrectal ultrasound guided (TRUS) prostate biopsy and the performance characteristics in this role match well with the clinical question raised. The role for MRI in initial biopsy, in pre-surgical planning before prostatectomy and in men on active surveillance is less well defined. A primary concern in the use of MRI is that of cost. MRI units are expensive, both in initial outlay and ongoing use. The availability of MRI varies widely between countries and even within regions of the same country. Different healthcare models have different approaches for allocating the use of expensive resources, including MRI, in times when they are scarce. Prostate MRI can be used at multiple points in the management algorithm of prostate cancer and each implies different cost concerns. In this review we present an overview of current research in cost and cost efficacy for the use of MRI in the management of prostate cancer. By examining what is known and highlighting areas of ongoing research we hope to provide the reader with a solid foundation for understanding these complex, ever-changing issues.

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

“…The cost of a mpMRI has been quoted as €345 in Europe, $524 in the USA, and $900 in Canada , while the addition of contrast has been estimated to cost $300 per case in Canada . The annual rate of prostate cancer in Europe was reported to be 350 000 cases .…”

Reducing Unnecessary Prostate Multiparametric Magnetic Resonance Imaging by Using Clinical Parameters to Predict Negative and Indeterminate Findings

“…Cost and availability depending on the health care environment 9 remain some of the major burdens for implementing mpMRI into clinical practice. Given the persisting limitations, an optimized risk assessment strategy to select patients most likely to benefit from mpMRI may help reduce unnecessary scans and improve the mpMRI cost-benefit ratio.…”

Impact of the MyProstateScore (MPS) test on the clinical decision to undergo prostate biopsy: results from a contemporary academic practice

“…Nonetheless, considering both (i) the practical limitations of mpMRI (e.g. subjective interpretation, high inter-reader variability, high relative cost and resource burden) 29,30 and (ii) the very high negative predictive value of MPS (98%) on recent validation, 31 MPS could be useful as a first-line test to rule-out high-grade cancer prior to more invasive testing.…”