THE PROSTATE - DECREASING COST-EFFECTIVENESS OF BIOPSY WITH ADVANCINGAGE

RATIONALE AND OBJECTIVES. The purpose of this study was to determine t he cost-effectiveness of prostate biopsy at different excess prostate- specific antigen (PSA) levels as a function of age. METHODS. Medical d ecision analysis was performed with standard software (SMLTREE) to det ermine marginal effectiveness in quality adjusted life years (QALYs) a nd marginal cost-effectiveness in dollars per QALY of immediate prosta te biopsy at different excess PSA levels between 0 ng/mL and 20 ng/mL. The probability of clinically significant cancer with a positive biop sy (pD(+)Bx(+)) was assumed to decrease with age from 1.0 at age 50 to 0.2 at age 70, Costs were based on charges at our hospital and were c onsidered over a 2-year time frame. RESULTS. With our base case assump tions there was a decrease in QALYs and an increase in costs doing an immediate prostate biopsy at all excess PSA levels between 0 ng/mL and 20 ng/mL compared with not biopsying the prostate at greater than or equal to 70 years, Doubling pD(+)Bx(+) from 0.2 to 0.4 in the 70-and-o lder age group resulted in a small increase in QALYs in biopsying the prostate at excess PSA levels between 0 ng/mL and 20 ng/mL, However, t he marginal cost-effectiveness of prostate biopsy was very high, rangi ng from $275,000/QALY biopsying at an excess PSA level of 0 ng/mL to $ 68,000/QALY biopsying at an excess PSA level of 20 ng/mL. This compare d with it being more effective and less costly to biopsy at all excess PSA levels greater than or equal to 0 ng/mL in 50-year old patients. CONCLUSION. Immediate prostate biopsy is not cost-effective and can be detrimental in patients greater than or equal to 70 years of age at a ll excess PSA levels between 0 ng/mL and 20 ng/mL.