Impact of adoption of a decision algorithm including PCA3 for repeat biopsy on the costs for prostate cancer diagnosis in France

Figures & data

Table 1.  Baseline characteristics of all men with a complete profile (n = 698) included in the French retrospective chart review.

Variable
Age, years
Mean (SD)	64.3 (7.4)
Median (range)	64 (42–86)
PSA, ng/ml
Mean (SD)	11.2 (22.7)
Median (range)	6.9 (0.4–335.0)
Prostate volume, cc
Mean (SD)	47.0 (20.2)
Median (range)	43 (10–120)
Suspicious DRE (%)	32.1
Number of cores taken*
Mean (SD)	12.1 (4.0)
Previous biopsies (%)
• 1 negative biopsy	13.2
• ≥2 negative biopsies	7.9

*Only collected for men with a positive PBx (n = 335).

Figure 1.  Percentage of men in whom prostate biopsy (PBx) is inappropriate according to RAM expert recommendations alone and with PCA3.

Table 2.  Default information included in the budget impact model for France.

Modifiers	Default
Number of biopsies in France20	225,000
Proportion of initial biopsies	78%
Distribution of PCA3 scores13,16,19	Initial biopsy	Repeat biopsy
• <20	39.7%	44.1%
• 20–35	20.2%	22.7%
• 35–50	10.1%	10.8%
• >50	30.0%	22.4%
Mean cost/biopsy20	€800
Mean cost complications/biopsy10,21–25	€280
Mean cost PCA3 testing	€300

Table 3.  Annual numbers of initial and repeat prostate biopsy (PBx) and associated costs under the current regimen (without PCA3 testing), and for the strategy assuming PCA3 testing before each planned repeat PBx (RAM + PCA3) for three different scenarios, i.e., if mean costs for complications per PBx are either €0 (Scenario 1), €100 (Scenario 2), or €280 (Scenario 3).

	Number of PBx			Costs: million Euros
	Initial PBx	Repeat PBx	Total	Scenario 1	Scenario 2	Scenario 3
Current practice	175,500	49,500	225,000	180.00	202.50	243.00
RAM + PCA3	175,500	31,155	206,655	180.17	200.84	238.04
Savings	0	18,345	18,345	−0.17	1.66	4.96
	(0%)	(37%)	(8.2%)

Table 4.  Distribution of PCA3 scores in European initial and repeat prostate biopsy (PBx) studies13,16 and in the French repeat PBx sub-group.

PCA3 range	Total (n = 1009)19, %	Initial (n = 516)16, %	Repeat (n = 463)13, %	Repeat France (n = 44), %
<20	41.5	39.7	44.1	30
20–34	21.6	20.2	22.7	20
35–50	10.5	10.1	10.8	23
>50	26.4	30.0	22.4	27

Rébillard X, Malavaud B, Rischmann P. Étude scientifique sur le dépistage individuel et le traitement précoce du cancer de la prostate en France. Marché 2007-OPEPES-01. Paris: Association Française d’Urologie. http://www.atoute.org/n/article118.html. Accessed November 2011

 Google Scholar

Haese A, de la Taille A, Van Poppel H, et al. Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol 2008;54:1081-8

 PubMed Web of Science ®Google Scholar

de la Taille A, Irani J, Graefen M, et al. Clinical evaluation of the PCA3 assay in guiding initial biopsy decisions. J Urol 2011;185:2119-25

 PubMed Web of Science ®Google Scholar

Van Poppel H, Haese A, Graefen M, et al. The relationship between Prostate CAncer gene 3 (PCA3) and prostate cancer significance. BJU Int 2012;109:360-6

 PubMed Web of Science ®Google Scholar

Roberts RO, Bergstralh EJ, Besse JA, et al. Trends and risk factors for prostate biopsy complications in the pre-PSA and PSA eras, 1980 to 1997. Urology 2002;59:79-84

 PubMed Web of Science ®Google Scholar