Decision analysis model comparing cost of multiparametric magnetic resonance imaging vs. repeat biopsy for detection of @entity263 in XXXX with prior negative findings on biopsy.

@entity1 @entity532 @entity263 @entity5
PURPOSE: We compared cost of multiparametric magnetic resonance imaging (MP-MRI) vs. repeat biopsy in detection of @entity263 ( @entity263 ) in @entity1 with prior negative findings on biopsy. METHODS: A decision tree model compared the strategy of office-based transrectal ultrasound-guided biopsy (TRUS) for @entity1 with prior negative findings on biopsy with a strategy of initial MP-MRI with TRUS performed only in cases of abnormal results on imaging. Study end points were cost, number of biopsies, and @entity5 detected. Cost was based on Medicare reimbursement. @entity532 were incorporated into analysis. Sensitivity analyses were performed by varying model assumptions. RESULTS: The baseline model with 24% @entity263 found that the overall cost for 100 @entity1 was  90,400 and  87,700 for TRUS and MP-MRI arms, respectively. The MP-MRI arm resulted in 73 fewer biopsies per 100 @entity1 but detected 4 fewer @entity5 (16 vs. 20.4) than the TRUS arm did. A lower risk of @entity263 resulted in lower costs for the MP-MRI arm and a small difference in detected @entity5 . At lower @entity5 rates, MP-MRI is superior to TRUS over a wide range of sensitivity and specificity of MRI. A lower sensitivity of MP-MRI decreases the cost of the MP-MRI, as fewer biopsies are performed, but this also reduces the number of @entity5 detected. CONCLUSIONS: The use of MP-MRI to select @entity1 for repeat biopsy reduced the number of biopsies needed by 73% but resulted in a few @entity5 being missed at lower cost when compared with the TRUS arm. Further studies are required to determine whether @entity5 missed represent clinically significant @entity5 .
