Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore

Table 5 Base case analyses of diagnostic strategies

Diagnostic strategy	Comparator	20 years horizon					25 years horizon	35 years horizon
Diagnostic strategy	Comparator	Costs (USD)	Incremental costs	Effectiveness (QALYs)	Incremental effectiveness	ICER (cost in USD per QALY gained)	ICER (cost in USD per QALY gained)
Strategy 1*: MRI targeted biopsy	–	9655	–	10.2236	–	–	–	–
Strategy 2*: MRI targeted biopsy ➔ Systematic biopsy	Strategy 1	10,062	408	10.2451	0.0215	18,975	16,211	14,084
Strategy 3: MRI targeted biopsy ➔ Saturation biopsy	Strategy 2	10,333	271	10.2408	−0.0042	Dominated by Strategy 2
Strategy 4*: MRI targeted biopsy ➔ Systematic biopsy ➔ Saturation biopsy	Strategy 2	10,357	295	10.2602	0.0152	19,458	15,915	14,106
Strategy 5: Systematic biopsy ➔ MRI targeted biopsy	Strategy 4	10,855	498	10.2358	−0.0245	Dominated by Strategy 4
Strategy 6: Systematic biopsy ➔ MRI targeted biopsy ➔ Saturation biopsy	Strategy 4	11,086	729	10.2516	−0.0086	Dominated by Strategy 4

Abbreviations: ICER incremental cost-effectiveness ratio, mpMRI multi-parametric magnetic resonance imaging, QALY quality-adjusted life year; USD, US dollar
Note:
1. MRI targeted biopsy refers to the administration of MRI targeted biopsy combined with systematic biopsy following a positive mpMRI.
2. Arrow (➔) refers to next sequence of diagnostic test following a negative biopsy result
3. The diagnostic strategies are organized from the least costly to most mostly strategy based on the analyses for 20-year time horizon. The incremental cost and effectiveness of each strategy is calculated by comparing against the preceding strategy that is not dominated. A dominated strategy is more costly and less effective than the strategy in the immediately preceding row. The strategies with asterisk (*) are not dominated; those without asterisk are dominated.
4. When Strategy 4 was compared against Strategy 1, the ICER was US$19175.

ISSN: 1472-6963