Economic evaluation of the introduction of the Prostate Health Index as a rule-out test to avoid unnecessary biopsies in men with prostate specific antigen levels of 4-10 in Hong Kong.
Janet BouttellJeremy TeohPeter K ChiuKevin S ChanChi-Fai NgRobert HeggieNeil HawkinsPublished in: PloS one (2019)
A recent study showed that the Prostate Health Index may avoid unnecessary biopsies in men with prostate specific antigen 4-10ng/ml and normal digital rectal examination in the diagnosis of prostate cancer in Hong Kong. This study aimed to conduct an economic evaluation of the impact of adopting this commercially-available test in the Hong Kong public health service to determine whether further research is justified. A cost-consequence analysis was undertaken comparing the current diagnostic pathway with a proposed diagnostic pathway using the Prostate Health Index. Data for the model was taken from a prospective cohort study recruited at a single-institution and micro-costing studies. Using a cut off PHI score of 35 to avoid biopsy would cost HK$3,000 and save HK$7,988 per patient in biopsy costs and HK$511 from a reduction in biopsy-related adverse events. The net cost impact of the change was estimated to be HK$5,500 under base case assumptions. At the base case sensitivity and specificity for all grades of cancer (61.3% and 77.5% respectively) all grade cancer could be missed in 4.22% of the population and high grade cancer in 0.53%. The introduction of the prostate health index into the diagnostic pathway for prostate cancer in Hong Kong has the potential to reduce biopsies, biopsy costs and biopsy-related adverse events. Policy makers should consider the clinical and economic impact of this proposal.
Keyphrases
- prostate cancer
- ultrasound guided
- healthcare
- public health
- mental health
- papillary thyroid
- radical prostatectomy
- fine needle aspiration
- high grade
- health information
- squamous cell
- benign prostatic hyperplasia
- human health
- high glucose
- emergency department
- health promotion
- big data
- low grade
- young adults
- machine learning
- risk assessment
- endothelial cells
- social media
- artificial intelligence
- adverse drug
- structural basis