ORIGINAL
PAPER
Cost analysis of ultrasound guided fusion-targeted prostate biopsy in the era of multiparametric MRI: Results from an Italian private health center Andrea Fandella 1, Umberto Barbaresi 2, Pietro Pepe 3, Lorenzo Bianchi Alessandro Bertaccini 2, 4. 1 2 3 4
2, 4,
Riccardo Schiavina
2, 4,
Urology Unit, Casa di Cura Rizzola, San Donà di Piave (VE), Italy; Department of Urology, S. Orsola Malpighi University Hospital, Bologna (BO), Italy; Urology Unit, Canizzaro Hospital, Catania (CT), Italy; Department of Experimental, Diagnostic, and Specialty Medicine - University of Bologna, Bologna (BO), Italy.
Objectives. Multiparametric magnetic resonance (mpMRI) of the prostate is recommended before performing a prostate biopsy, in order to improve the diagnosis of clinically significant prostate cancer and to reduce unnecessary procedures. The aim of this work is to quantify the overall costs of systematic prostate biopsy combined with MRI/TRUS fusion targeted biopsy. Material and methods. The overall costs were determined by referring to the experience of 289 procedures performed in Italy in 2019 in a private Urological Centre. The following cost factors were assessed: personnel, materials, maintenance-equipment depreciation, energy consumption and common costs of structure. Results. The overall cost of systematic plus mpMRI-guided biopsy was 581.00 EURO (€) if performed with MRI/TRUS fusion technique; data were obtained by summing up the costs of mpMRI, of personnel, hospital care, disposable items, use of the machine and costs of the structure. It can be assumed that the impact of a mpMRI fusion device can add from € 40 to € 120 to each procedure according to the initial cost of the machine, maintenance, any dedicated consumables, and operator time. Conclusions. MRI/TRUS fusion biopsy represents an accepted method for the diagnosis of PCa, with the most beneficial cost/effective rate. The feasibility of the procedure, in the immediate future, could be affected by the inhomogeneous use of mpMRI in the common clinical practice.
SUMMARY
KEY WORDS: Prostate cancer; targeted biopsy; fusion biopsy; imaging; cost analyses.
INTRODUCTION Prostate Cancer (PCa) is the most common neoplasm in men in Europe and USA (1).The diagnosis of PCa is differs from most of the other solid cancers in which imaging is vital to identify those patients who could require a biopsy and, often, to guide a targeted biopsy. Indeed, random and systematic sampling of the prostate have represented the gold standard to diagnose PCa (2). Transrectal ultrasound (TRUS) guided prostate biopsy has been the cornerstone of prostate cancer diagnosis. Systematic sextant biopsy protocol with 12 cores has been the gold standard for many years, despite a detection rate of about 40–45 at first biopsy setting (3). Until a few years ago, TRUS guided biopsy was indicated for 16% of the male population over 50 years old, with obvious economic consequences (4, 5). The introduction of multiparametric Magnetic Resonance
Imaging (mpMRI) of the prostate has deeply changed the diagnostic and therapeutic path for PCa (6-8). Compared to clinical evaluation with PSA dosage, digital rectal examination (DRE), TRUS and random biopsy, mpMRI enables accurate assessment of the location, size, and stage of the suspicious lesions within the prostate (9). With the aim of reducing unnecessary biopsies and increasing PCa detection rates, several techniques have been developed, with similar accuracy (10). The purest form of utilizing mpMRI to guide prostate biopsies is performing mpMRI and subsequent in-bore MRI-guided biopsy of the index lesions (11). While this approach demonstrates high quality performance characteristics, resource availability will likely limit its widespread use (12). A valid alternative is represented by the use of mpMRI and transrectal ultrasound Advances in Urological Diagnosis and Imaging - 2021; 4,1
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