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DOI: 10.1055/s-0031-1281601
© Georg Thieme Verlag KG Stuttgart · New York
Gesundheitsökonomische Evaluation einer Magnetresonanzbildgebung vor Biopsie zur Diagnose von Prostatakarzinomen
Health-Economic Evaluation of Magnetic Resonance Imaging Before Biopsy for Diagnosis of Prostate CancerPublication History
eingereicht: 28.4.2011
angenommen: 10.6.2011
Publication Date:
23 August 2011 (online)

Zusammenfassung
Ziel: Ziel dieser Studie war eine gesundheitsökonomische Analyse der Anwendung der MR-Bildgebung in der Diagnostik des Prostatakarzinoms (PCa) vor Durchführung einer ersten Prostatabiopsie. Material und Methoden: Die gesundheitsökonomische Analyse erfolgte in 4 Schritten: Modellerstellung, Bestimmung der Wahrscheinlichkeiten, Evaluierung und Sensitivitätsanalysen. Es wurde eine Effektivitätsanalyse aus Patientenperspektive sowie eine Kosten-Effektivitäts- und eine Kosten-Nutzwert-Analyse aus Sicht der Krankenkassen für Österreich und Deutschland durchgeführt. Die Effektivitäts- bzw. die Kosten-Effektivitäts-Analyse erfolgte an einer hypothetischen Kohorte von 100 000 Patienten. Die Ergebnisparameter waren Anzahl der Biopsien und der detektierten PCa bzw. Kosten. Für die Kosten-Nutzwert-Analyse wurden die Ergebnisparameter quality adjusted life years (QALYs) und Kosten für einen Patienten berechnet. Ergebnisse: Die Effizienzanalyse zeigte, dass durch Anwendung der MRT vor einer ersten Prostatabiopsie ca. 64 000 unnötige Biopsien/ 100 000 Patienten verhindert werden können. Die diagnostische Effizienz war um den Faktor 1,7 höher. Durch MRT wurden 8 PCas mehr detektiert. Aus Sicht der Krankenkasse war die Anwendung der MRT nicht kosteneffektiv. Für 100 000 Patienten wurden Mehrkosten von ca. 42 Mio. € bzw. 650 € pro verhinderter Biopsie errechnet. Die Kosten pro detektiertem PCa waren um 1395 € höher. Die erzielbaren QALYs waren leicht höher, weshalb die Handlungsalternative mit MRT nicht dominiert war. Schlussfolgerung: Die Ergebnisse lassen keine eindeutige Empfehlung für oder gegen die Anwendung der MRT in der Primärdiagnostik des PCa zu. Aus Patientensicht ist es durch die höhere medizinische Effizienz klar zu befürworten, allerdings ist es für die Krankenkasse mit höheren Kosten verbunden.
Abstract
Purpose: The aim of this study was the health-economic analysis of MR imaging in the diagnostics of suspicious prostate carcinoma (PCa) before execution of a first biopsy. Materials and Methods: The health-economic analysis included four steps: modeling, determination of probabilities, evaluation, and sensitivity analyses. We performed an effectiveness analysis from the patient perspective as well as a cost-effectiveness and a cost-utility analysis from the health insurance perspective for Austria and Germany. The effectiveness and cost-effectiveness analysis used a hypothetical cohort of 100 000 patients. The result parameters were number of biopsies, number of detected PCa, and monetary costs. For the cost-efficiency analysis, the result parameters, quality-adjusted life years (QALYs) and costs, were calculated for an individual patient. Results: The efficiency analysis showed that MRI before a first biopsy can prevent ca. 64 000 unnecessary biopsies/ 100 000 patients. The diagnostic efficiency was higher by a factor of 1.7. Due to MRI, eight PCas were additionally detected. From a health insurance perspective, MRI was not cost-effective. Extra costs of ca. 42 m. € per 100 000 patients and of 650 € per prevented biopsy were calculated. The costs per detected PCa were increased by 1395 €. The attainable QALYs were a little higher for the MRI alternative, which was therefore not dominated. Conclusion: Our results do not permit a clear recommendation for or against the application of MRI in the diagnostics of PCa. From the patient perspective, it is to be endorsed due to the higher medical efficiency. However, it is connected with higher health insurance costs.
Key words
prostate - neoplasms - MR imaging - health economic analysis - cost - effectiveness
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