@article{MRA, author = {Michael Nichol and Joanne Wu and Dwight Denham and Jin–Wen Hsu and Mark Reynolds and Stanley Frencher and Ronald Loo and Steven Jacobsen}, title = { Cost-Effectiveness of Prostate Health Index from a Managed Care Payer Perspective}, journal = {Medical Research Archives}, volume = {2}, number = {12}, year = {2015}, keywords = {prostate-specific antigen (PSA), free PSA, PSA precursor form p2PSA assay, prostate health index (phi), cost-effectiveness analysis}, abstract = {Objective: The prostate health index (phi) has been shown to improve diagnostic accuracy in prostate cancer (Pca) detection compared with total and free serum prostate-specific antigen (PSA).  The study assessed the cost-effectiveness of early Pca detection with phi plus PSA, compared with the PSA test alone, from a managed care organization perspective.Study Design: Cost-effectiveness analysis. Methods: A Markov model estimated expected costs and utilities of Pca detection and consequent treatment using four strategies in men aged 50-75 years. The strategies differed with the PSA test thresholds (≥2 or ≥4 ng/mL) and methods (PSA alone vs. PSA plus phi) to determine need for a prostate biopsy.  The transition probabilities were derived from the electronic medical records of males in Kaiser Permanente Southern California during 1998-2007.  Health state utilities and prostate cancer-related treatment costs were obtained from the published literature.Results:  The most cost-effective strategy used the PSA plus phi at PSA 2-10 ng/mL to determine need for a prostate biopsy, which had the lowest cost and highest effectiveness [cost/effectiveness (C/E)=13,650/15.491, \$1,099/QALY].  Next was PSA plus phi at PSA 4-10 ng/mL [C/E=14,095/12.364, \$1,140/QALY), followed by PSA test at threshold ≥4 ng/mL [C/E=15,256/12.304, \$1,240/QALY), or PSA ≥2 ng/mL [C/E=15,789/12.287, \$1,285/QALY).  PSA plus phi at PSA 2-10 ng/mL displayed a 74% to 86% probability of being cost-effective at a willingness-to-pay range of 0 to \$150,000/QALY gained. Conclusions: Using the strategy PSA plus phi at PSA 2-10 ng/mL for Pca detection dominated other strategies, and was an optimal strategy under a willingness-to-pay of \$150,000/QALY gained. }, issn = {2375-1924}, url = {https://esmed.org/MRA/mra/article/view/375} }