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

Bouttell, J. , Teoh, J., Chiu, P. K., Chan, K. S., Ng, C.-F., Heggie, R. and Hawkins, N. (2019) 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. PLoS ONE, 14(4), e0215279. (doi:10.1371/journal.pone.0215279) (PMID:30990840)

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Abstract

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.

Item Type:Articles
Additional Information:Open access is supported by the Hong Kong Health and Medical Research Fund Research Fellowship Scheme reference No 02160047 to JT. The authors received no other specific funding for this work.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Bouttell, Mrs Janet and Heggie, Mr Robert and Hawkins, Professor Neil
Authors: Bouttell, J., Teoh, J., Chiu, P. K., Chan, K. S., Ng, C.-F., Heggie, R., and Hawkins, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in PLoS ONE 14(4):e0215279
Publisher Policy:Reproduced under a Creative Commons License

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