When something is described as cost-effective, what does that mean? According to the Merriam Webster Dictionary, it indicates the thing or action produces good results without costing a lot of money.

There is no question that multiparametric MRI (mpMRI) of the prostate, performed on a high-power 3T magnet, produces good results. In fact, when interpreted by an experience reader, it produces great results for both patient and doctor. The high resolution, 3D portrait of a man’s prostate gland is so faithful to what Mother Nature designed that it has revolutionized the detection, diagnosis and treatment of prostate disorders, particularly prostate cancer (PCa). According to one paper, mpMRI “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.”^[i]

And yet, we hear time and again that mpMRI is too expensive for widespread use. This belief has the effect of keeping diagnostic and treatment choices limited to relatively cheap TRUS biopsies and relatively expensive whole-gland treatments for PCa.

Back in 2016, we posted a blog on three ways in which mpMRI can save millions of healthcare dollars by preventing incorrect diagnosis, reducing routine overtreatment of patients with insignificant disease, and managing side-effects of prostatectomy and radiation. A year later, Gordon et al. ran an analysis of costs and conditionally concluded, “Diagnosis of prostate cancer through mpMRI technology would be cost-effective if it leads to increased uptake of AS [Active Surveillance] for men with confirmed very-low or low-risk prostate cancer.”^[ii] In 2018, a Dutch study concurred, with the authors concluding that an AS strategy using mpMRI with or without biopsy “improves quality of life and costs decrease.”^[iii]

Now, in 2022 the journal Value in Health Regional Issues featured an article specifically comparing the diagnostic cost-effectiveness of pre-biopsy mpMRI to aid in targeting suspicious lesions. The authors conducted a review of published literature, choosing 9 high-quality papers. Their criteria included both patients undergoing initial biopsy or those with previous negative biopsy. They also included three targeting methods: TRUS-guided cognitive (that is, the doctor placing needles under ultrasound guidance in accordance with what is seen on MRI), MRI/ultrasound fusion, and real-time MRI guidance in the bore of the magnet. In all three instances, MRI planning and guidance is “more cost-effective than TRUS-guided biopsy alone.”^[iv]

Computing the economic value of in-bore mpMRI targeted biopsy vs. conventional TRUS biopsy solely on factors such as equipment and facility costs is pathetically shortsighted. Obviously, the price of a magnet and the vault it’s housed in will far exceed that of a small ultrasound device placed in a urology examining room. While that may be the initial consideration, saving healthcare dollars is a global issue and requires calculations over a longer period of time. Think about such MRI-related advantages as:

• More efficient, accurate diagnosis
• Fewer biopsy side effects
• Better treatment planning, including focal therapies
• Reduce hospital costs
• Support for Active Surveillance (the least costly management option)
• Fewer treatment-related incontinence and sexual morbidities requiring longer-term care
• Better quality of life and patient satisfaction—something hard to put a dollar value on, but worth noting.

If we examine economic analyses of mpMRI in relation to PCa, in just the past six years we see a cumulative body of calculations that should silence the naysayers who claim that it’s too expensive to incorporate mpMRI in routine patient diagnosis and treatment. We applaud the Australian team who took the long view (nearly 10 years) for their 2021 assessment of prostate MRI’s impact on their healthcare economy; they estimated “the annual savings from reduced number biopsies and biopsy associated complications to be $13.2 ± 9.6 million.” If you compare Australia’s population of 25.69 million with our own 329.5 million people, you can imagine the dollar amount we would responsibly save.

We hope it’s numbers like these that can put the rest the narrow-minded belief that it’s too expensive to add mpMRI to the PCa diagnosis/treatment pathway, once and for all.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Hutchinson R, Lotan Y. Cost consideration in utilization of multiparametric magnetic resonance imaging in prostate cancer. Transl Androl Urol. 2017;6(3):345-354.
[ii] Gordon LG, James R, Tuffaha HW, Lowe A, Yaxley J. Cost-effectiveness analysis of multiparametric MRI with increased active surveillance for low-risk prostate cancer in Australia. J Magn Reson Imaging. 2017 May;45(5):1304-1315
[iii] Patel S, Rongen JJ, Fütterer JJ, Boltyenkov A, Rovers MM. The Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Men with Low-risk Prostate Cancer: A Cost-effectiveness Modeling Study. Eur Urol Oncol. 2018 Dec;1(6):476-483.
[iv] Rezapour A, Alipour V, Moradi N, Arabloo J. Cost-Effectiveness of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy Versus Systematic Transrectal Ultrasound-Guided Biopsy for Prostate Cancer Diagnosis: A Systematic Review. Value Health Reg Issues. 2022 Jan 15;30:31-38.