Cost-effectiveness of office-based, magnetic resonance imaging-guided transperineal versus transrectal prostate biopsy: An economic analysis of the PREVENT trial.

[BACKGROUND] As antimicrobial resistance increases, safer alternative approaches to prostate biopsy are needed. PREVENT was a multi-institutional, randomized controlled trial comparing transperineal (TP) biopsy without antibiotic prophylaxis versus transrectal (TR) biopsy with targeted prophylaxis. The authors conducted a secondary cost-effectiveness analysis of PREVENT.

[METHODS] The authors designed a Markov model with a simulated cohort of 1000 biopsied men. They assessed the short-term cost-effectiveness over a 2-week period, comparing relative costs in US dollars and utility measured in quality-adjusted life years (QALYs). The strategies they compared were office-based, magnetic resonance imaging-guided biopsy using two approaches: (1) TP without antibiotics; or (2) TR with targeted antibiotic prophylaxis. Analysis was from a health care payer perspective using a willingness-to-pay (WTP) threshold of $100,000/QALY. Probabilistic sensitivity analysis was performed with 5000 Monte Carlo simulations.

[RESULTS] Compared to TR, TP was dominant, offering lower cost and higher utility per patient. This finding was robust to sensitivity analyses with TP having >89% probability of cost-effectiveness regardless of WTP threshold. TP remained dominant when real-world infection rates were used. TP biopsy needed to prevent >0.5% infections compared to TR to maintain cost-effectiveness. Per 1000 patients, TP biopsy prevented 16 infections, and the additional cost to prevent a single infection was $3.18/patient.

[CONCLUSIONS] In this model, TP biopsy was more cost-effective than TR from a health care payer perspective. In the setting of increasing concerns about the risk of infection from traditional TR biopsy, these findings suggest that office-based TP biopsy is a more cost-effective population-level alternative.