Cost-utility analysis of MR imaging-guided transurethral ultrasound ablation for the treatment of low- to intermediate-risk localised prostate cancer

BMJ Open. 2025 Jan 11;15(1):e088495. doi: 10.1136/bmjopen-2024-088495.

Abstract

Background: Magnetic resonance-guided transurethral ultrasound ablation (MR-TULSA) is a new focal therapy for treating localised prostate cancer that is associated with fewer adverse effects (AEs) compared with established treatments. To support large-scale clinical implementation, information about cost-effectiveness is required.

Objective: To evaluate the cost-utility of MR-TULSA compared with robot-assisted radical prostatectomy (RARP), external beam radiation therapy (EBRT) and active surveillance (AS) for patients with low- to favourable intermediate-risk localised prostate cancer.

Design, setting and participants: A Markov model was developed targeting 60-year-old men diagnosed with low- to intermediate-risk localised prostate cancer over a time horizon of 40 years from the German Statutory Health Insurance (SHI) perspective. To assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed.

Intervention: Four different treatment strategies were compared: minimally invasive MR-TULSA, two definitive approaches (RARP and EBRT) and one observational strategy (AS).

Outcome measurements and statistical analysis: Outcomes were measured in overall costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER).

Results: AS generated the highest number of QALYs (12.67), followed by MR-TULSA (12.35), EBRT (12.35) and RARP (12.20). RARP generated the lowest costs (€ 46 997) over one patient's lifetime, while MR-TULSA was a slightly more expensive alternative (€48 826). The incremental cost-effectiveness ratio (ICER) of AS compared with RARP was €11 600 per QALY and of MR-TULSA compared with RARP was €12 193 per QALY, while EBRT was dominated. At a willingness-to-pay of €20 000 per QALY, the probability of being cost-effective is 44% for AS, 25% for RARP, 25% for MR-TULSA and 6% for EBRT.

Conclusions: All treatment options for 60-year-old men diagnosed with low- to intermediate-risk localised prostate cancer are affected by considerable uncertainty. Accepting high follow-up costs by applying a higher willingness-to-pay, AS is the most favourable treatment option.

Keywords: HEALTH ECONOMICS; Health Care Costs; Prostate disease; Urological tumours.

MeSH terms

  • Cost-Benefit Analysis*
  • Germany
  • Humans
  • Magnetic Resonance Imaging / economics
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging, Interventional / economics
  • Male
  • Markov Chains*
  • Middle Aged
  • Prostatectomy / economics
  • Prostatectomy / methods
  • Prostatic Neoplasms* / diagnostic imaging
  • Prostatic Neoplasms* / economics
  • Prostatic Neoplasms* / surgery
  • Quality-Adjusted Life Years*
  • Robotic Surgical Procedures / economics
  • Robotic Surgical Procedures / methods
  • Transurethral Resection of Prostate / economics
  • Transurethral Resection of Prostate / methods
  • Watchful Waiting / economics