Cost-Effectiveness of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy Versus Systematic Transrectal Ultrasound-Guided Biopsy for Prostate Cancer Diagnosis: A Systematic Review.

OBJECTIVES: This study aimed to systematically review the cost-effectiveness studies of multiparametric magnetic resonance imaging (mpMRI)-guided biopsy (MRGB) compared with systematic transrectal ultrasonography (TRUS)-guided biopsy for diagnosing prostate cancer (PCa). METHODS: PubMed, Web of Science core collection, Embase and Scopus, and reference lists of the included studies were searched with no date and language restrictions through January 2020 for full economic evaluation studies (cost-effectiveness, cost-utility analysis, cost-benefit analysis) that assessed mpMRI and MRGB compared with systematic TRUS-guided biopsy or other sequential biopsy strategies in men undergoing initial prostate biopsy or men with previous negative prostate biopsy, with clinical suspicion of PCa based on abnormal prostate-specific antigen or digital rectal examination increase or both. Data were tabulated and analyzed using narrative synthesis. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Finally, 9 studies were included. All studies were conducted in high-income countries. All studies found that mpMRI and MRGB was cost-effective in the initial and before repeat biopsy in men with previous negative biopsy. The cognitive-targeted TRUS-guided biopsy was cost-effective in the initial biopsy (dominant or cost-effective at willingness-to-pay threshold of the countries); it was not evaluated for repeat biopsy in men. The direct in-bore magnetic resonance imaging (MRI)-guided biopsy was cost-effective for the initial biopsy (€323 per quality-adjusted life-year gained). The superiority of one of the targeted biopsy approaches (fusion, cognitive, or in-bore) over other approaches has not yet been established. CONCLUSIONS: This study showed that pre-TRUS-guided biopsy MRI is more cost-effective than TRUS-guided biopsy alone. Furthermore, the use of MRI-ultrasound fusion targeted biopsy in the diagnosis of PCa in the initial biopsy and repeat biopsy and cognitive-targeted TRUS-guided biopsy in the initial biopsy is cost-effective.