Cost-effectiveness of office-based, magnetic resonance imaging-guided transperineal versus transrectal prostate biopsy: An economic analysis of the PREVENT trial.

Abstract

As antimicrobial resistance increases, safer alternative approaches to prostate biopsy are needed. PREVENT was a multi-institutional, randomized controlled trial comparing transperineal (TP) biopsy without antibiotic prophylaxis versus transrectal (TR) biopsy with targeted prophylaxis. The authors conducted a secondary cost-effectiveness analysis of PREVENT. The authors designed a Markov model with a simulated cohort of 1000 biopsied men. They assessed the short-term cost-effectiveness over a 2-week period, comparing relative costs in US dollars and utility measured in quality-adjusted life years (QALYs). The strategies they compared were office-based, magnetic resonance imaging-guided biopsy using two approaches: (1) TP without antibiotics; or (2) TR with targeted antibiotic prophylaxis. Analysis was from a health care payer perspective using a willingness-to-pay (WTP) threshold of $100,000/QALY. Probabilistic sensitivity analysis was performed with 5000 Monte Carlo simulations. Compared to TR, TP was dominant, offering lower cost and higher utility per patient. This finding was robust to sensitivity analyses with TP having >89% probability of cost-effectiveness regardless of WTP threshold. TP remained dominant when real-world infection rates were used. TP biopsy needed to prevent >0.5% infections compared to TR to maintain cost-effectiveness. Per 1000 patients, TP biopsy prevented 16 infections, and the additional cost to prevent a single infection was $3.18/patient. In this model, TP biopsy was more cost-effective than TR from a health care payer perspective. In the setting of increasing concerns about the risk of infection from traditional TR biopsy, these findings suggest that office-based TP biopsy is a more cost-effective population-level alternative.