58 Background: A proportion of men with low-risk prostate cancer managed expectantly with active surveillance (AS) go on to definitive treatment in part due to initial understaging during transrectal ultrasound (TRUS) guided biopsy. Newer diagnostic tools including genomic tumor profiling, magnetic resonance (MR) imaging, and MR-ultrasound fusion biopsy have been advocated as effective strategies to risk-stratify men prior to entry into AS. We developed a decision analytic model to determine the cost-effectiveness of various initial management options for low-risk prostate cancer. Methods: A decision tree was constructed with repeat TRUS guided biopsy, MR imaging, genomic tumor profiling, and radical prostatectomy as initial management options with downstream Markov nodes to model annual recurring risks of continued AS, definitive treatment, and death from other causes. Value was optimized from the societal perspective over a lifetime horizon. We evaluated model heterogeneity and assumptions on the probability of understaging and test performance characteristics using Monte Carlo microsimulation and probabilistic sensitivity analysis. Results: At a willingness-to-pay (WTP) threshold of $100,000 per quality adjusted life year (QALY), immediate radical prostatectomy and genomic tumor profiling were dominated strategies with higher costs and lower effectiveness. MR imaging with MR-ultrasound fusion biopsy when targetable lesions are identified was the optimal strategy across 93% of simulations with an incremental cost-effectiveness ratio of $1,096 per QALY. Eliminating uncertainty in our model would lead to cost savings and increased effectiveness. This expected value of perfect information was $516 per patient. Conclusions: With multiple initial management options for low-risk prostate cancer, clinical decision-making can be challenging. Cost-effectiveness analysis demonstrates that image-guided biopsy techniques deliver optimal value from both a patient and societal perspective. However, given the prevalence of low-risk prostate cancer, there is value to be obtained from additional research to optimize management strategies.
MP15-05 COST-EFFECTIVENESS ANALYSIS OF INITIAL MANAGEMENT STRATEGIES FOR LOW-RISK PROSTATE CANCER
