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27-06-2022 | Prostate cancer | Adis Journal Club | Article

PharmacoEconomics

Cost-Effectiveness Analysis of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) for the Primary Staging of Prostate Cancer in Australia

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Authors: Rachel Song, Varinder Jeet, Rajan Sharma, Martin Hoyle & Bonny Parkinson

Abstract

Background and Objectives

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) combined with computed tomography (CT) is a new imaging modality to detect the extra-prostatic spread of prostate cancer. PSMA PET/CT has a higher sensitivity and specificity than conventional imaging (CT ± whole body bone scan [WBBS]). This study conducted a cost-utility analysis of PSMA PET/CT compared with conventional imaging for patients with newly diagnosed, intermediate-risk or high-risk primary prostate cancer.

Perspective

Australian healthcare perspective.

Setting

Tertiary.

Methods

A decision-analytic Markov model combined data from a variety of sources. The time horizon was 35 years. The sensitivity and specificity of PSMA PET/CT and CT alone were based on meta-analyses and the test accuracy of CT+WBBS was based on a single randomised controlled trial. Health outcomes included cases detected, life-years, and quality-adjusted life-years. Costs related to other diagnostic tests, initial treatment, adverse events, and post-disease progression were included. All costs were reported in 2021 Australian Dollars (A$).

Results

The deterministic incremental cost-effectiveness ratio of PSMA PET/CT was estimated to be A $21,147/quality-adjusted life-year gained versus CT+WBBS, and A$36,231/quality-adjusted life-year gained versus CT alone. The results were most sensitive to the time horizon, and the initial treatments received by patients diagnosed with metastatic cancer. The probability of PSMA PET/CT being cost effective was estimated to be 91% versus CT+WBBS and 89% versus CT alone, using a threshold of AU$50,000/quality-adjusted life-year gained.

Conclusions

PSMA PET/CT is likely to be more costly than CT+WBBS or CT alone in Australia; however, it is still likely to be considered cost effective compared with conventional imaging.

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Key Points for Decision Makers

Prostate-specific membrane antigen positron emission tomography combined with computed tomography is a new and more accurate method to detect prostate cancer.

Previous studies estimated that prostate-specific membrane antigen positron emission tomography/computed tomography is likely to be cost saving compared with conventional imaging.

We found that prostate-specific membrane antigen positron emission tomography/computed tomography is likely to be more costly than computed tomography plus a whole-body bone scan or computed tomography alone in Australia; however, it is still likely to be considered cost effective for patients with newly diagnosed, intermediate-risk or high-risk primary prostate cancer.