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Cost analysis of prostate cancer detection including the prostate health index (phi)

World Journal of Urology volume 37, pages 481–487 (2019)Cite this article

Abstract

Objective

To assess the economic impact of introducing the prostate health index (phi) for prostate cancer (PCa) detection.

Methods

A total of 177 patients who presented in an academic institution with a tPSA between 2 and 10 ng/ml and underwent prostate biopsies within the 3 months were enrolled. With phi and tPSA thresholds of 43 and 4 ng/ml, respectively, probability for each branch of a decision tree model for PCa diagnosis and corresponding mean cost were estimated with “Monte Carlo” simulations. A sensitivity analysis was performed.

Results

With a similar sensitivity, phi strategy increased positive predictive value by 13.9 points and negative predictive value by 31.6 points in comparison to tPSA strategy. Mean costs per patient with tPSA and phi strategies were €514 and €528, respectively, for a phi test price at 50€. One-way sensitivity analysis showed that phi strategy was less expensive (508€/patient) than tPSA strategy with a phi test price below 30€. In multi-criteria sensitivity analysis, PPV and the rates of positive phi and tPSA were the parameters with the largest impact on the final cost as opposed to the cost of the biopsy or imaging which have less influence. With an expected rate of positive phi test < 60%, tPSA strategy was more expensive than phi strategy.

Conclusions

The introduction of phi index in PCa detection would result in a significant clinical benefit compared to tPSA strategy. In our economic model, the phi strategy was equivalent or slightly more expensive than the current tPSA strategy.

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Author information

Affiliations

  1. Department of Urology, Service D’urologie, Rennes University Hospital, Hôpital Pontchaillou, 2, rue Henri Le Guillou, 35000, Rennes, France

    Romain Mathieu, Tarek Fardoun, Benoit Peyronnet, Karim Bensalah & Sébastien Vincendeau

  2. BESPIM Department, Nimes University Hospital, Nimes, France

    Christel Castelli

  3. Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria

    Shahrokh F. Shariat

  4. Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

  5. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  6. Karl Landsteiner Institute, Vienna, Austria

    Shahrokh F. Shariat

Authors
  1. Romain Mathieu
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  2. Christel Castelli
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  3. Tarek Fardoun
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  4. Benoit Peyronnet
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  5. Shahrokh F. Shariat
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  6. Karim Bensalah
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  7. Sébastien Vincendeau
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Contributions

Protocol/project development: CC and SV; data collection or management: RM, CC, TF, and SV; data analysis: RM, CC, SFSh, BP, KB, and SV; manuscript writing/editing: RM, CC, TF, BP, SFS, KB, and SV

Corresponding author

Correspondence to Romain Mathieu.

Ethics declarations

This study has been approved by the appropriate ethics committee.

Conflict of interest

This work was supported with an unrestricted educational grant from Beckman Coulter, Brea, California, USA. Beckman Coulter Inc. provided editorial comments on the manuscript. The authors declare that the analyses and the manuscript writing were performed independently.

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Mathieu, R., Castelli, C., Fardoun, T. et al. Cost analysis of prostate cancer detection including the prostate health index (phi). World J Urol 37, 481–487 (2019). https://doi.org/10.1007/s00345-018-2362-z

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  • DOI: https://doi.org/10.1007/s00345-018-2362-z

Keywords

  • Prostate-specific antigen (PSA)
  • Prostate health index (phi)
  • Prostatic neoplasm
  • Diagnosis
  • Cost analysis