PSMA-PET imaging not the most cost-effective option for many prostate cancer patients
Though beneficial, the use of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) exams in patients with recurrent cancer might not be the most cost-effective option. At least not for everyone, according to new research published this week in JAMA Network Open.
PSMA-PET imaging is routinely used to evaluate advanced metastatic disease. Although the exam effectively helps providers manage patients’ treatment options, for some patients, the resulting costs associated with said treatments may negate the value of its findings.
“The treatment paradigm for advanced prostate cancer continues to evolve with the integration of new agents, potentially obscuring the magnitude of differences that are attributable to enhanced detection alone,” Natalia Kunst, PhD, with the Center for Health Economics at the University of York, United Kingdom, and colleagues explained. “Despite these uncertainties, empirical evidence suggests that PSMA-PET imaging is commonly associated with earlier use of expensive systemic therapies that are now recommended in the first-line setting.”
The group suggested that tailoring strategies based on PSA level, patient preference, and quality and expectancy of life “may better balance trade-offs associated with next-generation imaging.”
To get a better idea of cost-effectiveness, researchers conducted an economic evaluation to estimate lifetime health and cost outcomes related to the use of PSMA-PET in patients with biochemical recurrence (BCR) of prostate cancer. They developed a decision-analytic model using data from published studies of patients with BCR to compare three imaging strategies for men whose prostate cancer returned after surgery or radiation: PSMA-PET alone, PSMA-PET used only if standard scans (CT and bone scan) were unclear and CT/bone scan alone. Lifetime costs and health benefits for each approach were measured in quality-adjusted life-years (QALYs) and overall costs to see which method offered the best value.
The model determined that up-front PSMA-PET in this cohort offered the highest mean QALYs, at 7.12, compared to 6.55 for the CT/bone scan route. However, on average, the PSMA-PET option resulted in around $100,000 more in treatment and follow-up expenses compared to CT/bone scans. This equates to an incremental cost-effectiveness ratio (ICER) of $172,000 per QALY, which exceeds the group’s willingness to pay threshold of $150,000 per QALY.
In patients with lower PSA levels (<2 ng/mL), PSMA-PET yielded an ICER of $113,000 per QALY, making it a more cost-friendly route in this cohort.
“This economic evaluation found that while the use of PSMA-PET for all patients with recurrent prostate cancer should currently not be considered cost-effective, personalizing decision-making about imaging, such as favoring PSMA-PET among patients with lower PSA distributions in whom salvage therapies may be curative, could represent a cost-effective strategy,” the authors noted.
The authors suggested that more long-term research is needed to fully understand how these findings could be used to improve population health.
Read the full study here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.