The prostate health index (phi) test is cost-effective in decision making for initial prostate biopsy in clinical practice, according to a recent study published in Frontiers in Oncology (2020;10:565382. doi:10.3389/fonc.2020.565382).
“Clinical studies have suggested that [phi] outperforms prostate-specific antigen (PSA) tests in prostate cancer detection. The cost-effectiveness of phi with different cutoffs is poorly understood in the context of decision making for prostate biopsy,” wrote Da Huang, MD, Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China, and colleagues.
This multicenter cohort study enrolled 3348 patients with elevated total PSA. Patients underwent initial prostate biopsy from August 2013 to May 2019. A decision model was developed to evaluate the cost-effectiveness ratio of different phi cutoffs.
Total costs and reimbursement payments were based on the fee schedule of Shanghai Basic Medical Insurance and converted into US dollars. Additionally, willingness-to-pay thresholds were estimated as 1 to 3 times the average gross domestic product per capita of China ($7,760 or $23,279, respectively).
The total costs of prostate biopsy were $315, PSA tests were $19, and phi test varied between $72 to $130. The phi test predicted reductions of 21.7% to 50.2% in unnecessary biopsies under phi cutoffs from 23 to 35. Quality adjusted life-years increased 23.77-57.58 compared with PSA tests.
“Using phi test was cost-effective in the decision-making process for initial prostate biopsy, especially for patients with tPSA values between 2–10 ng/ml,” concluded Dr Huang and colleagues.
“The phi cutoff of 27 was cost-effective regardless of tPSA ranges and should be recommended from a health-economic perspective,” they added—Lisa Kuhns
