Cost-effectiveness evaluation of initial prostate cancer diagnosis using PSA and multiparametric magnetic resonance imaging in the Brazilian private sector: a comparison between systematic biopsy and MRI-first strategy
Marcella Leite Deverlan, Daniel de Iracema Gomes Cubero, Luiz Vinicius de Alcantara Sousa, Auro del Giglio
Abstract
Background: Prostate cancer is highly prevalent, and current PSA-only screening leads to overdiagnosis and unnecessary biopsies. Recent trials show that using multiparametric MRI (mpMRI) as triage before biopsy reduces invasive procedures without missing clinically significant tumors. Objective: To evaluate the cost-effectiveness of an MRI-first strategy vs. traditional systematic biopsy for initial prostate cancer diagnosis in the Brazilian private healthcare sector. Methods: A decision-tree model based on Göteborg-2 trial data was developed using TreeAge Pro. The analysis adopted the private payer perspective, with a time horizon limited to the initial diagnostic episode. Effectiveness was defined as detection of clinically significant prostate cancer (ISUP ≥ 2). Direct medical costs were obtained from three sources: Delboni/Dasa (V1), Hospital Sírio-Libanês (V2), and an estimate for supplementary health operators (V3). Two scenarios were evaluated: Scenario A (mpMRI included in both strategies) and Scenario B (mpMRI only in the MRI-first arm). Deterministic sensitivity analyses varied MRI costs by ±20%. Results: The MRI-first strategy was dominant across all scenarios and cost sources. In Scenario A (V1), mean costs were R$ 6,000.20 (MRI-first) vs. R$ 8,893.16 (systematic biopsy), with effectiveness of 0.35 vs. 0.17, respectively (ICER: dominated). In Scenario B (V1), costs were R$ 6,000.20 vs. R$ 6,159.24, maintaining higher effectiveness for MRI-first (0.35 vs. 0.17). Results remained robust across V2 and V3, and in sensitivity analyses with ±20% variation in MRI costs. Within each cost source, the cost-effectiveness ratio (cost per clinically significant cancer detected) was consistently lower for the MRI-first strategy than for systematic biopsy (e.g., R$ 17,143 vs. R$ 52,313 for V1; R$ 25,690 vs. R$ 77,644 for V2; and R$ 10,710 vs. R$ 32,489 for V3 in Scenario A), confirming the superior efficiency of the MRI-first approach across all evaluated cost structures. Conclusions: The MRI-first approach is a cost-effective and dominant strategy for initial prostate cancer diagnosis in the Brazilian private setting across all evaluated scenarios, reducing unnecessary biopsies while optimizing detection of clinically significant tumors and promoting efficient resource allocation.
Keywords
Referências
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Submetido em:
14/04/2026
Revisado em:
19/05/2026
Aceito em:
04/06/2026
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