Imperial College London
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Professor Hashim Ahmed

Faculty of Medicine, Department of Surgery & Cancer

Chair in Urology (Clinical)
 
 
 
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Contact

 

hashim.ahmed

 
 
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Location

 

5L28Lab BlockCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Faria:2017:10.1016/j.eururo.2017.08.018,
author = {Faria, R and Soares, MO and Spackman, E and Ahmed, HU and Brown, LC and Kaplan, R and Emberton, M and Sculpher, MJ},
doi = {10.1016/j.eururo.2017.08.018},
journal = {European Urology},
pages = {23--30},
title = {Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS).},
url = {http://dx.doi.org/10.1016/j.eururo.2017.08.018},
volume = {73},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI). OBJECTIVE: To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS). INTERVENTION: Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs. RESULTS AND LIMITATIONS: The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92-0.98] vs 0.91 [95% CI 0.86-0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer. CONCLUSIONS: An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines. PATIENT SUMMARY: We found that, under certain assumptions, the use of multiparametri
AU  - Faria,R
AU  - Soares,MO
AU  - Spackman,E
AU  - Ahmed,HU
AU  - Brown,LC
AU  - Kaplan,R
AU  - Emberton,M
AU  - Sculpher,MJ
DO  - 10.1016/j.eururo.2017.08.018
EP  - 30
PY  - 2017///
SN  - 0302-2838
SP  - 23
TI  - Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS).
T2  - European Urology
UR  - http://dx.doi.org/10.1016/j.eururo.2017.08.018
UR  - http://hdl.handle.net/10044/1/51714
VL  - 73
ER  -
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