I’m excited to start 2014 by summarizing how MRI detection and diagnosis can reduce long term medical costs, from the viewpoint of both patients and the medical insurance industry. A new Dutch study compares MRI-guided biopsy with TRUS-guided biopsy along the lines of accuracy, costs and long term quality of life. The study has gone into press in the journal European Urology.
The article, “Cost-effectiveness of Magnetic Resonance (MR) Imaging and MR-guided Targeted Biopsy Versus Systematic Transrectal Ultrasound-Guided Biopsy in Diagnosing Prostate Cancer: A Modelling Study from a Health Care Perspective,”[i] was based on actual Dutch health care costs; a meta-analysis of existing peer-reviewed studies on the accuracy and quality of life (QOL) impact of both types of biopsies; and the creation of projection models going out 10 years that calculated cost effectiveness and QOL cost burdens. To the best of the authors’ knowledge, this comprehensive calculation is the first of its kind.
The study notes that TRUS biopsies generate a problematic diagnostic pathway due to limitations of ultrasound imaging. Clinically significant tumors may be missed while detecting insignificant tumors can lead to overtreatment; a negative biopsy will lead to annual PSA/DRE tests, with a strong possibility of repeat biopsies; TRUS biopsies require a minimum of 10-12 needles with the attendant risks of infection and structural damage; and many patients experience. MRI-guided biopsies, on the other hand, improve the diagnostic pathway in several ways: if no suspicious region is visible, no biopsy is done in favor of periodic MRI monitoring; a targeted MRI-guided biopsy involves far fewer needles yet results in more accurage diagnosis; tumors that qualify for focal ablation open treatment options with far less negative impact on QOL.
The authors found that, in terms of Dutch medical economics, the actual costs for MRI-guided biopsy vs. TRUS biopsy were almost equivalent, with MRI slightly more expensive in the very short term. It’s the longer term comparison that is most interesting. By eliminating repeat TRUS biopsies and by filtering out the need for overtreatment, not to mention the expenses related to therapies for treatment side effects (incontinence, impotence) substantial healthcare savings can be realized over 10 years. Just as important, patients who can safely monitor their prostates via MRI or who are candidates for a minimalist focal treatment enjoy significantly less risk to their QOL, generating both economic and personal cost effectiveness.