Evaluation of the Cost-Effectiveness of Novel Tests in the Screening and Diagnostic Phases of Prostate Cancer Compared to Current Practice

Sammanfattning: Introduction: There are major limitations in the current methods for screening and diagnosis of prostate cancer. In this project, the implementation of new tests has been researched. The assessed tests in the screening phase are the 4Kscore, Prostate Health Index (PHI), Magnetic Resonance Imaging (MRI) and Prostarix. The assessed tests for use after a negative biopsy are Prostate Cancer gen 3 (PCA3), ConfirmMDx, Prostate Core Mitomic Test (PCMT), PHI and the 4Kscore. The aim was to evaluate the cost-effectiveness of introducing these tests compared to the current use of Transrectal Ultrasound-Guided Biopsies (TRUSGB) or MRI-Guided Biopsies (MRGB). Methodology: A systematic literature review was conducted to collect all available clinical utility studies regarding the tests. Markov models were developed based on a previously published TRUSGB model to estimate Quality-Adjusted Life Years (QALY) gained and costs for the tests over 5, 10, 15 and 20 years. Results: The resulting models were for 4Kscore, PHI, PCA3 and ConfirmMDx. Compared to the current method 4Kscore and PHI showed better results while ConfirmMDx and PCA3 were equal. Only 4Kscore showed better potential than the MRGB method. Conclusion: Compared to the TRUSGB and MRGB methods, implementation of the 4Kscore test was the dominating strategy. More clinical utility studies are needed to confirm the results.