Funding of prostate magnetic resonance imaging leads to fewer biopsies and potential savings to health systems in the management of prostate cancer

Abstract

Objectives To assess the impact of the introduction of multiparametric magnetic resonance imaging of the prostate (mpMRIp) on the number of prostate biopsies performed in Australia. Methods Australian Medicare published statistics from 1 July 2007 to 30 June 2019 were obtained from publically available databases for prostate‐specific antigen (PSA) testing, prostate biopsy, and mpMRIp. Analysis was divided into three time periods broadly based on availability of mpMRI to the Australian public: 2007–2012 (no mpMRIp), 2012–2018 (mpMRIp available, privately funded), and 2018–2019 (mpMRIp available with Medicare funding). Introduction of mpMRIp was hypothesised to reduce the number of prostate biopsies performed. PSA testing numbers were used as a control. The economics model, proposed by the Medical Services Advisory Committee (MSAC), was analysed for cost savings. Results Accounting for variations in PSA testing, the introduction of mpMRIp from 2012 coincided with a reduction in the number of prostate biopsies by an average of 354.7/month (95% CI 175, 534.4; P < 0.001). Whilst the number of mpMRIp performed for the initial 12 months was underestimated by the MSAC at 38 470 vs 20 149 (+$8.3 million Australian dollars), we estimate the annual savings from reduced number biopsies and biopsy‐associated complications to be $13.2 ± 9.6 million. Conclusion Availability of mpMRIp in Australia has correlated with a significant reduction in prostate biopsy rates, with an estimated annual saving of $13.2 ± 9.6 million. Government funding of this diagnostic service has the potential to improve health equity and save on health expenditure.

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“…In Australia, multiparametric MRI (mpMRI) of the prostate gland has also become available under Australian government funded rebate for diagnostic evaluation of suspected PCa and active surveillance of low-risk PCa with economic analysis suggesting significant savings to the health system 4 5. mpMRI offers reliable visualisation and characterisation of csPCa compared with the traditional transrectal ultrasound (TRUS), and is seen to have greater sensitivity of detection for lesions greater than 1 cm, Gleason score of ≥7 and index lesions compared with satellite lesions, thus enabling better selection of patients for prostate biopsy 6.…”

Sensible government decisions on funding for imaging can change practice and deliver better care for men with prostate cancer

“…On top of this, the estimated annual savings from a reduced number of biopsies and biopsy-associated complications is A $13.2 AE 9.6 million. In summary, the availability of mpMRI in Australia has correlated with a significant reduction in prostate biopsy rates, with huge annual savings to the health system [4].…”