Table 2.
Model input parameters
| Parameter | Estimate | 95% CI | Distribution assumed in PSA | Source/notes |
|---|---|---|---|---|
| Specificity for mpMRI = Pr(mpMRI-|Healthy) | 0.548 | 0.435–0.657 | Normal | Hao et al. [28] |
| Sensitivity for mpMRI (G ≤ 6) | 0.715 | 0.614–0.798 | ||
| Sensitivity for mpMRI (G ≥7) | 0.931 | 0.893–0.956 | ||
| Sensitivity for standard biopsy (G ≤6) | 0.860 | 0.824–0.889 | ||
| Sensitivity for standard biopsy (G ≥7) | 0.897 | 0.809–0.947 | ||
| Sensitivity for mpMRI-targeted biopsy (G ≤ 6) | 0.753 | 0.568–0.875 | ||
| Sensitivity for mpMRI-targeted biopsy (G ≥ 7) | 0.934 | 0.889–0.962 | ||
| Slope of log odds of G7 at onset | 0.03905 | Variance: 1.686e−4 |
Multivariate normal Covariance: 1.079e−05 |
Calibration |
| Slope of log odds of G ≥ 8 at onset | 0.2453 | Variance: 1.78e−06 | ||
| Costs (£) | ||||
| PSA test | £21 | 17–25 | Gamma | NICE guideline [27]. Based on cost of a PSA test kit and nurse consultation |
| Polygenic risk stratification | £25 | 20–30 | Callender et al. [13] Estimated from costs charged to NHS hospitals for prostate cancer genome-wide association studies | |
| Biopsy (systematic/MRI targeted) | £581 | 465–697 | Callender et al. [13] Weighted average of cost of transrectal ultrasound-guided and perineal biopsy. Includes relevant histopathology, potential admission for sepsis and cost of a urological appointment | |
| Multiparametric MRI | £339 | 271–407 | NICE guideline. Includes time of two radiographers, an appointment with a consultant, and equipment, administration and consumable costs | |
| Assessing suspected prostate cancer | £545 | 436–654 | Callender et al. Includes an isotope bone scan, assessment by a urological multi-disciplinary team and a further outpatient urological appointment | |
| Prostatectomy | £9808 | 7846–11,770 | Callender et al. Includes an appointment with a urologist and a weighted average of the cost of major open, robotic and laparoscopic radical prostatectomies from NHS reference costs | |
| Radiation therapy | £6462 | 5170–7754 | Callender et al. Includes an appointment with a clinical oncologist, preparation for intensity modulated radiation therapy and outpatient delivery of treatment on a megavoltage machine | |
| Active surveillance (yearly) | £577 | 462–692 | Callender et al. Hao et al. Includes cost of 3 PSA tests and 2 urological appointments Assumes a third of men will need an annual mpMRI and biopsy | |
| Palliative care/terminal illness | £7383 | 5906–8860 | Round et al. [29] Model assumed terminal care for the 6 months prior to a death due to prostate cancer and palliative care for the 6–30 months prior | |
| Utility estimates (measured by EQ-5D) | ||||
| Biopsy | 0.90 | 0.87–0.94 | Normal | Hao et al. Decrement assumed for 3 weeks |
| Cancer diagnosis | 0.80 | 0.75–0.85 | Hao et al. Decrement assumed for 1 month | |
| Prostatectomy part 1 | 0.83 | 0.73–0.91 | Hao et al. Decrement assumed for 2 months | |
| Prostatectomy part 2 | 0.89 | 0.88–0.91 | Hao et al. Decrement assumed for 10 months | |
| Radiation therapy part 1 | 0.82 | 0.75–0.88 | Hao et al. Decrement assumed for 2 months | |
| Radiation therapy part 2 | 0.83 | 0.88–0.91 | Hao et al. Decrement assumed for 10 months | |
| Active surveillance | 0.90 | 0.85–0.95 | Hao et al. Decrement assumed for 7 years | |
| Post-recovery period | 0.86 | 0.84–0.88 | Hao et al. Decrement assumed for 9 years | |
| Palliative therapy | 0.62 | 0.58–0.66 | Hao et al. Decrement assumed for 1 year | |
| Terminal illness | 0.40 | Held constant | Hao et al. Decrement assumed for 6 months | |
| EQ-5D index population norms 18–24 | 0.934 | Held constant | Janssen and Szende [30] | |
| 25–34 | 0.922 | |||
| 35–44 | 0.905 | |||
| 45–54 | 0.849 | |||
| 55–64 | 0.804 | |||
| 65–74 | 0.785 | |||
| 75+ | 0.734 | |||
CI confidence interval, EQ-5D EuroQol 5D, G Gleason score, mpMRI multi-parametric magnetic resonance imaging, NICE National Institute for Health and Care Excellence, NHS National Health Service, PSA prostate-specific antigen