Prostate MRI Reduces Biopsies, Lowers Costs

Making multiparametric MRI of the prostate (mpMRIp) more available not only reduces the number of biopsies, but it can also lead to significant healthcare savings, new research reveals.

In a study published in BJU International, investigators from St. Vincent’s Hospital Melbourne and The University of Melbourne in Australia demonstrated that providing government-funded mpMRIp leads to significant clinical benefit.

“Our research shows publicly funded prostate MRI not only represents good policy in terms of health equity, but it also makes sense from a financial perspective,” said lead study author Thomas Whish-Wilson, M.D., general surgeon at St. Vincent’s.

mpMRIp is already recognized for its potential in diagnosing prostate cancer and as a substitute to clinical exams and prostate specific antigen (PSA) screening. This research outlines its other benefits, as well, Whish-Wilson said. Once it was introduced into practice in Australia, the number of prostate biopsies fell by an average of 354.7 per month with an associated estimated annual savings of $13.2 million.

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To determine the impact of the introduction of mpMRIp, as well as the effect of government funding, Whish-Wilson’s team examined the records from the Australian Government Department of Human Services publicly accessible database of Medicare-funded services. They specifically concentrated on records from men who were suspected of having prostate cancer based on family history, elevated PSA, and biopsy, as well as those who were under active surveillance.

The team analyzed records from Jan. 1, 2007, to June 30, 2019, and they divided the records into three timeframes:

• 2007-2012: no mpMRIp offered
• 2012-2018: mpMRI offered with private funding
• 2018-2019: mpMRI offered with Medicare funding

In an effort to assess the financial impact, they assigned a $2,400 price tag to an individual biopsy, and they added the direct savings from the drop in biopsies being taken to the projected savings from reduced re-admissions for biopsy-related complications over the financial year. To do this, they multiplied the annual biopsy reduction rate by the cost of performing a prostate biopsy in a public hospital, the team said.

Overall, they identified an average reduction in prostate biopsies of 354.7 per month. This correlated to a $13.2 +/- $9.6 million cost savings, they said.

More specifically, using a general linear model, the team determined that after private funding was introduced for mpMRIp in 2012, prostate biopsies fell by 501.6 monthly. The same model also revealed that for every 1,000 PSA tests, providers ordered 10.7 prostate biopsies. After accounting for changes in PSA testing, the team said, introducing mpMRIp still pointed to a decline in biopsies.

Their data also showed a clear plummet in the number of PSA tests and biopsies. Between 2007 and 2008 when mpMRIp was not available, 919,975 PSA tests were conducted along with 24,647 biopsies. Roughly a decade later – 2018 to 2019 after Medicare funding was available – the numbers dropped to 692,021 PSA tests and 19,923 biopsies.

According to these results, Whish-Wilson’s team said, it can be inferred that a growing number of radiologists are beginning to order this test.

And, even those this analysis was based on Australian services and data, their results can be applied to other locations, they said.

“The present study has international implications for countries looking to improve access and affordability to appropriate screening and diagnostic models for ‘at-risk’ men,” they said.