Volume 66, Issue 3, Pages 430-436 (September 2014) Cost-effectiveness of Magnetic Resonance (MR) Imaging and MR-guided Targeted Biopsy Versus Systematic Transrectal Ultrasound–Guided Biopsy in Diagnosing Prostate Cancer: A Modelling Study from a Health Care Perspective  Maarten de Rooij, Simone Crienen, J. Alfred Witjes, Jelle O. Barentsz, Maroeska M. Rovers, Janneke P.C. Grutters  European Urology  Volume 66, Issue 3, Pages 430-436 (September 2014) DOI: 10.1016/j.eururo.2013.12.012 Copyright © 2013 European Association of Urology Terms and Conditions

Fig. 1 Scatter plot of probabilistic sensitivity analysis for magnetic resonance imaging (MRI) versus transrectal ultrasound–guided biopsy (TRUSGB) strategies, including the total costs. (A) The MRI strategy is less effective and more expensive; (B) the MRI strategy is more effective and more expensive; (C) the MRI strategy is less effective and less expensive; (D) the MRI strategy is more effective and less expensive. The summary point (orange diamond) shows that the expected total costs of the MRI strategy are €31 higher than those for the TRUSGB strategy, while the corresponding quality-adjusted life years are 0.10 higher for the MRI strategy. The probability that the MRI strategy is more effective than the TRUSGB strategy is 80% (B+D). The probability that the MRI strategy is both more effective and less costly is 25% (D). QALY=quality-adjusted life year. European Urology 2014 66, 430-436DOI: (10.1016/j.eururo.2013.12.012) Copyright © 2013 European Association of Urology Terms and Conditions

Fig. 2 Cost-effectiveness acceptability curve showing the probability that each strategy is the most cost-effective for a range of values of willingness to pay (WTP) per quality-adjusted life year (QALY). For a WTP for the gain of a QALY of zero, the probability of magnetic resonance imaging (MRI) as the optimal strategy is 32. At WTP values of €1000 per QALY and higher, MRI becomes the strategy most likely to be cost-effective. At WTP values of €10 000 and higher, the MRI strategy is around 80% likely to be cost-effective. mp-MRI=multiparametric magnetic resonance imaging; QALY=quality-adjusted life year; TRUSGB=transrectal ultrasound–guided biopsy. European Urology 2014 66, 430-436DOI: (10.1016/j.eururo.2013.12.012) Copyright © 2013 European Association of Urology Terms and Conditions

Fig. 3 Scatter plot of probabilistic sensitivity analysis for magnetic resonance imaging (MRI) versus transrectal ultrasound–guided biopsy (TRUSGB) strategies, analysing diagnostic costs only. (A) The MRI strategy is less effective and more expensive; (B) the MRI strategy is more effective and more expensive; (C) the MRI strategy is less effective and less expensive; (D) the MRI strategy is more effective and less expensive. The summary point (orange diamond) shows that the expected treatment costs of the MRI strategy are €140 higher than those for the TRUSGB strategy, while the corresponding quality-adjusted life years are 0.10 higher for the MRI strategy. QALY=quality-adjusted life year. European Urology 2014 66, 430-436DOI: (10.1016/j.eururo.2013.12.012) Copyright © 2013 European Association of Urology Terms and Conditions

Fig. 4 Scatter plot of probabilistic sensitivity analysis for magnetic resonance imaging (MRI) versus transrectal ultrasound–guided biopsy (TRUSGB) strategies, analysing treatment costs only. (A) The MRI strategy is less effective and more expensive; (B) the MRI strategy is more effective and more expensive; (C) the MRI strategy is less effective and less expensive; (D) the MRI strategy is more effective and less expensive. The summary point (orange diamond) shows that the expected diagnostic costs of the MRI strategy are €109 lower than those for the TRUSGB strategy, while the corresponding quality-adjusted life years are 0.10 higher for the MRI strategy. QALY=quality-adjusted life year. European Urology 2014 66, 430-436DOI: (10.1016/j.eururo.2013.12.012) Copyright © 2013 European Association of Urology Terms and Conditions

Fig. 5 Incremental net monetary benefit (iNMB) for different values for sensitivity of magnetic resonance–guided biopsy (MRGB), probability of significant tumour, and probability of tumour in men with an elevated prostate-specific antigen level. For all three parameters, values range from 0% to 100%. We calculated iNMBs by multiplying the incremental effects of the magnetic resonance imaging (MRI) strategy over the transrectal ultrasound–guided biopsy (TRUSGB) strategy with the Dutch willingness to pay per quality-adjusted life year (€80 000) [39] and subtracting the incremental costs. A negative iNMB, presented in blue, indicates that the MRI strategy is not cost-effective, while a positive iNMB (orange) indicates that the MRI strategy is the most cost-effective strategy. The figure shows that regardless of the probability of a significant tumour or the probability of a tumour, the iNMB is positive and the MRI strategy is cost-effective. For values of the sensitivity of MRGB ≤10%, the iNMB is negative (the MRI strategy is not cost-effective), while for values ≥20%, the iNMB is positive, implying that the MRI strategy is cost-effective. MRGB=magnetic resonance–guided biopsy; MRI=magnetic resonance imaging; TRUS=transrectal ultrasound. European Urology 2014 66, 430-436DOI: (10.1016/j.eururo.2013.12.012) Copyright © 2013 European Association of Urology Terms and Conditions

European Urology 2014 66, 430-436DOI: (10.1016/j.eururo.2013.12.012) Copyright © 2013 European Association of Urology Terms and Conditions